Preamble

The House met at Eleven of the Clock, Mr. SPEAKERin the Chair.

PRIVATE BUSINESS.

Mersey Tunnel Bill,

Sidmouth Urban District Council Bill,

Lords Amendments considered, and agreed to.

Worksop Corporation Bill [Lords],

Read the Third time, and passed, with Amendments.

Dearne District Traction Bill [Lords],

As amended, considered; to be read the Third time.

SUMMARY JURISDICTION (APPEALS) BILL.

Lords Amendments to be considered upon Thursday next, and to be printed. [Bill 144.]

ROAD TRAFFIC (AMENDMENT) BILL,

"to restrict the application of the provisions of section one hundred and sixteen of the Road Traffic Act, 1930, to loss arising by reason of the repeal by the said Act of provisions relating to the licensing of public service vehicles by local authorities," presented by Mr. Stanley; supported by Lieut.-Colonel Headlam; to be read a Second time upon Monday next, and to be printed. [Bill 143.]

SELECTION (STANDING COM MITTEES).

STANDING COMMITTEE B.

Mr. WILLIAM NICHOLSON: reported from the Committee of Selection; That they had discharged the following Member from Standing Committee B (added in respect of the Service of Process (Justices) Bill and of the Ad-
ministration of Justice (Miscellaneous Provisions) Bill [Lords]): Mr. Grimston; and had appointed in substitution: Mr. Turton.

Report to lie upon the Table.

ORDER OF THE DAY.

SUPPLY.

[14TH ALLOTTED DAY—FIRST PART.]

Considered in Committee.

[Captain BOURNE in the Chair.]

CIVIL ESTIMATES, 1933.

CLASS V.

MINISTRY OF HEALTH.

Motion made, and Question proposed,
That a sum, not exceeding £13,200,445, be granted to His Majesty, to complete the sum necessary to defray the Charge which will come in course of payment during the year ending on the 31st day of March, 1934, for the Salaries and Expenses of the Ministry of Health; including Grants and other Expenses in connection with Housing, certain Grants to Local Authorities, &c., Grants in Aid in respect of Benefits and Expenses of Administration under the National Health Insurance Acts, certain expenses in connection with the Widows', Orphans', and Old Age Contributory Pensions Acts, and other Services."— [Note: £6,000,000 has been voted on account.]

11.7 a.m.

The MINISTER of HEALTH (Sir Hilton Young): I shall not detain the Committee very long on the actual figures of the Estimate except in giving such explanation as is usually required. I would refer in the first place to the Vote for £39,000,000 in Class 9 for the block grants to the local authorities. On that Vote there is an increase of £195,000, which is due entirely to the new money which the House voted the other day for the second grant period, in accordance with the original scheme of 1929. As a set-off against that new money there are decreases of certain other grants owing to changes in the weighted population and alterations in boundaries. The Committee will note that that increase is simply the result of the automatic working of previous legislation, over which there is no control on my part or on the part of the Administration.
I now turn to Class 5, which is the actual Vote for my Department and amounts to £19,000,000. There, I am glad to say, there is a decrease of £135,800, an important matter in these difficult days. That decrease is the
balance of increases and decreases. The principal increase is an increase in housing grants of about £250,000, which is due to the normal increase in acceptances of houses for subsidy in the course of past years. That amount would have been very much greater had it not been for the fact that by legislation we have ceased the Wheatley subsidies and all subsidies except those for slum clearance and rural reconditioning.
As against that increase in respect of housing, there is a decrease of £375,000 on the Health Insurance Vote, which is due principally to the Act of 1932. It is also due, I am glad to say, to the fact that we had to vote in 1932 £120,000 in view of the influenza epidemic. Owing to the fact that that epidemic has not recurred, that amount of expenditure has not been necessary this year. Long may it not be required.
Finally, on this Vote there is one small decrease of £2,800 in respect of the administration of my Department. It is a small sum, but it is the result of a very big effort, because the staff of the Ministry of Health is constantly increasing on account of the expanding health services. Fresh work is continually being placed upon my Department by the legislation of this House. There is, therefore, in the normal course of things a steady increase in the expenditure of the Ministry of Health, and if this year we have not an increase but a decrease in the cost of the Department it is the result of a very strenuous effort on the part of those concerned in the administration of the Department to reduce expenditure, while seeking to acquire the maximum efficiency. These figures show that we shall this year be doing a good deal more work at a good deal less cost than in the previous year.
I should like to make some observations upon the principal factors of the national welfare in so far as they come within the sphere of administration of the Ministry of Health. I can report progress on them as regards the past year, and in doing so I will give an outline of what our view is on the present situation in regard to these great factors of national welfare, and the outlook for the future. In these great health services one is constantly finding out the conspicuous untruth of the old saw that it is no good going to meet one's difficulties. In
regard to national health, you have to meet the difficulties that are coming. Foresight is most essential for efficient administration of health services. I should like, at the outset, to dwell upon some of the measures which we have taken to ensure the future, because I believe they are the most important part of our work. I cannot cover the whole field. I can only give some samples of the kind of pioneer work, anticipatory work, that we can undertake.
I will mention the difficult question of the sterilisation of the unfit. The Committee knows how anxious a question that is and how enormous is the expense of the mental deficiency service. But more important than expense is the great gravity of that disadvantage in our national life of mental deficiency. The Committee knows, too, how uncertain is the public mind on the question of sterilisation. We have started an enquiry which will enable us to ascertain the facts and I trust that the Committee undertaking the inquiry will be able to report before very long. The inquiry is not to pronounce on the question of policy. Only this House can do that, and it can only do it when the nation's mind is more made up than it is at the present time. The Committee will ascertain the facts and place them before the country, in order that it may come to a sound judgment upon this vital matter.
I will give another sample of the looking-ahead work which we have to do. I refer to the menace to public health in the accumulation of those great ranges of refuse around our cities, London in particular. They are potential sources of danger to public health. The methods of dealing with them in the past have not been adequate, and at present there is a good deal to be done. One cannot guarantee that at the moment there is no danger to public health from a further accumulation of these great mountains of refuse. I have taken the initiative in setting up a new consultative committee of the municipal corporation of London, the 28 borough councils and the City Corporation, in order to co-ordinate their interests to those of the localities where these refuse dumps are situated, and as a result of this effort of co-ordination we hope to see a great improvement in the future.
Let me give one other sample of our planning ahead. In the past there has been a lack of reasonable uniformity in the standards of the great buildings and public institutions in our large cities, hospitals, workhouses and municipal institutions. I do not put forward uniformity as a merit in itself, I mean uniformity as to what is the right standard of construction. It is, of course, necessary to adapt it to local requirements, but I feel, that it is absolutely essential to efficiency and economy that there should be some normal standards for the construction of these buildings. This is strongly recommended by the report of the Committee over which the hon. Member for Richmond (Sir W. Ray) presided, and I have started an inquiry which will have the effect of establishing the standards and also provide permanent machinery for keeping the standards up-to-date.
Last, and most important, in the work of planning and foresight is the actual work of town and country planning, the lay-out and organisation of our towns and countryside for the preservation of their economic assets on the one hand and the amenities of life on the other. The Act which was passed last year has given a great impetus to this work, and it is being pushed forward as rapidly as possible by the influence of the Ministry. At the time of the passing of the Act there was a certain amount of criticism partly of the Ministry for the long time taken to get schemes passed, and I am glad to say that by a substantial effort of hard work we have succeeded in sweeping away and clearing out all outstanding schemes which were ready for settlement. As a result of the Act there has, however, been a great recrudescence of activity which we welcome, but I can assure the Committee and local authorities that the Department is now ready to proceed with any and every scheme which comes along, without any hitch or delay, to the conclusion of the various stages.
So far I have dealt with some samples of the planning work which we have to do for the future. Let me turn to a matter which at the present time naturally occupies the anxious attention of every student of the welfare of the country and of those responsible for the national wellbeing; that is the state of the nation in
regard to the great essentials of health and welfare. These great essentials are, first shelter, secondly food, and thirdly health and freedom from disease. Let me say a word or two about the work of the Government in regard to each of these matters. First in regard to shelter, that is housing supply, and housing policy. I am not going to detain the Committee this morning by going over the general argument for the Government's housing policy. Hon. Members know what it is. It is to give a stimulus to private enterprise; a restoration of the normal forces of supply, thereby securing an increase of small houses, coupled with a great attack upon the crying evil of the slums.
Let me say a word as to the present state of affairs in regard to carrying out that policy. In the first place, one is glad to recognise that accompanying this policy—the ending of the epoch of general subsidies and the concentration on slum clearance—and largely due to it, has been a marked increase in the activity of the building trade. I will give the Committee the relevant figures to satisfy them that this is the case. From January to May this year there has been a drop of 131,000 in the number of unemployed in the building trade, a very marked drop, a much bigger drop than we have seen in recent years even at this time of the year. That is an abnormal decrease in the unemployment in the building trade since January. Let me give another figure which is a more substantial element still as showing the increase in the activity of the building trade. The returns from local authorities, from the principal urban areas, show that for the first five months of this year, 1933, there has been a very substantial increase in the actual number of building plans passed. Last year the value of the plans passed during the first five months was £26,000,000, but this year the figure has gone up to £34,000,000. That is most convincing evidence of a very welcome return of activity in the building trade.

Sir FRANCIS FREMANTLE: Is that the figure for residential houses or for building generally?

Sir H. YOUNG: For building generally. It is a large figure, much too big to refer to one section of housing. Another question which I know has specially exercised the minds of the most instructed students
on these questions and those who are acquainted with the needs of the country in regard to housing, is the transition period; from the period of the subsidy to the period of full activity of private enterprise. It was a fear lest the transition period should be accompanied by a drop in the supply of houses. It is a natural fear; and a fear which I entirely share. We took measures to provide against it, which I have already described on a previous occasion, and I am glad to say that the figures show that so far there has been no drop, practically no falling off, in house production during the transition period.

Mr. LOGAN: Can the right hon. Gentleman say what subsidy is now being carried?

Sir H. YOUNG: If the hon. Member will excuse me I will give only those figures which are relevant to my argument, and while that point is interesting it is not relevant to what I am saying. The figures show that there has been no falling off in production. The first illuminating figure is the number of State assisted houses actually under construction. That is what I have described in previous Debates as the overlap of houses constructed with subsidy to cover the transition period. At the end of May, 1932, the figure was 33,000. At the end of May, 1933, it was 32,000, or practically the same number. So that at present there is no diminution in the rate of construction of assisted houses. That is what we wanted during the transition period, to cover the transition.
So much for the present. Now as to the future. The future will be shown by the number of houses, assisted and unassisted, which have been approved for construction by local authorities under various schemes. The number of houses approved in the first five months of 1932 was 17,600. In the first five months of 1933 it was 17,800, actually a little more. So the effort in housing by the local authorities has actually not diminished at all. [An HON. MEMBER: "Does that include flats?"] Yes, all local authority schemes. The moral is that there has been no diminution so far during the transition period in the activity of the local authorities since last year. That is what is wanted. Let us look at the general record for last year, for the 12
months to 1st April, which is the last date for which I have the figures. What has been the total number of houses, assisted and unassisted—all houses—completed in those 12 months Up to 1st April, 1932, the total was 200,800. In the 12 months to 1st April, 1933, it was 200,600. Those are practically identical numbers, showing that there has been no diminution so far in the rate of production of houses. The total is most encouraging and is the successful result of the plans which we made to prevent there being any shock to house production during the transition from subsidies to the full play of normal forces in house production.
But, of course, I should be giving a false picture of the whole orientation of Government policy as regards housing if I did not bring clearly into relief and into the forefront the national campaign against slums. The Committee know that we are in the most interesting and critical period of that campaign. I asked the local authorities to produce their plans before the end of September, and the local authorities are at work making their plans for a five years' programme. It is not possible to over-estimate the importance of the effort we are now undertaking. This is a matter in which it behaves everyone of us to use his influence, the Government's influence, the influence of every private Member, to make sure that the efforts of those who are responsible in the front line, the local authorities, shall be adequate to the requirements of the nation.
This question stands high above party. A most significant lead was given, in the first place, by the Members of the Royal House, and by the Prince of Wales in particular; and, secondly, by the leaders of all the great churches of the country. It is too early for me to give any account of what the actual conspectus of the plans will be. I am encouraged by the spirit in which the work has been taken up by the local authorities. I believe that the work is going well. Let me give a sample in the first scheme under the new effort. It comes from Stoke-on-Trent, and I will tell the Committee what that scheme is. I welcome this dove from the Ark as it were, or, to continue the ornithological simile, this first swallow of the full summer which will come later. In the past Stoke-on-Trent has cleared only 245
The new scheme, in accordance with the spirit of the nation, is to clear 3,612 houses, and to clear them at the rate of 720 a year. If we see that spirit reflected throughout the country in all the schemes, we shall indeed have succeeded in our object. We give a full mark, so to speak, to Stoke-on-Trent for giving this good lead to all others.
Now I turn from shelter to food. There is no question which must more anxiously concern the Minister and the Ministry of Health, under such conditions as the present, than the nutrition of the people. One must ask oneself from day to day, how is the country standing these long depressions; how is it standing the diminution of national resources; how is it standing the exhaustion of private resources; what is the effect? Does it need emergency action here or there, in order to make sure that there is no positive malnutrition in the country? What should we expect? We should expect to see the depressed conditions of the times beginning to tell upon the health of the country. There is nobody but could be under apprehension of that. Certainly a Minister of Health must be on the alert for symptoms of it.
In what I have to say let me make it clear that we are deeply conscious in our hearts and minds of the deprivation and hardships which unemployment and bad times inflict upon large sections of the community. No one is belittling them or pretending that people are well off, and that all is for the best in this world. It is not. There is deprivation. There are bad times. There is nearness to the margin of life due to the bad times throughout the country, with the distress which it causes. What I want to look at is the actual physical effect as shown in the statistics. There are two different effects-the effect upon the body, that is disease, and the effect upon the mind. Again let me say that the result of the widespread and close inquiry which I have been carrying on as to the state of the nation's health, in view of the depression, is this: It has been made quite clear to me that unemployment, the anxieties of life, the insecurity of employment, undoubtedly tell upon the mental state of the unemployed. Anxiety, worry, trouble, disappointment, the vexation of being unable to continue the
occupation by which a man is proud to make his way in the world, particularly in the case of the young-these things do indeed produce states of mind which are unhealthy. They effect the mental health of the nation, and we must make full allowance for them.
I turn from that to the physical health of the nation and here I find surprisingly, for indeed it is to me surprising, that I can give a different account to the Committee, but I must tell the Committee the truth of my investigations and the results, both those which were to be expected as well as those which were unexpected. Let me first, before proceeding to give the Committee the results of the continuous watch which is kept upon national health, particularly from the point of view of nutrition, indicate the sources from which our information is derived. At the Ministry of Health we have, of course, sources of information on this subject far wider than could be available in any other inquiry. We have the school medical officers all over the country and their reports to the Board of Education. We have the medical officers of health all over the country and their reports to the local authorities. We have the regional medical officers in connection with the health services who are in very close touch With the health of people relevant to this inquiry. Then we have the inspectors of the Ministry who keep a constant watch over the whole country and who possess wide knowledge and deep experience on this question.
Last and most important, there are the actual statistics of mortality and morbidity for the country. Let me briefly summarise the evidence drawn from these various sources on the actual health of the nation at the present time. Perhaps the most important evidence of all is, as I have said, the evidence of statistics and the figures show that the mortality for the whole country and for the depressed areas in particular is steadily declining. That is a very striking circumstance and a testimony to the maintenance of the general health of the people.

Mr. LUNN: Is the right hon. Gentleman taking in account the figures of maternal mortality?

Sir H. YOUNG: If the hon. Gentleman will give me the opportunity of developing the matter I will deal with that
point. I assure him that I am, not going to conceal from the Committee any single relevant fact. In 1932 the death rate of the whole country was 12 per thousand. That was equal to the average rate from 1921 to 1930 and it has been steadily declining up to the present time. The next striking feature, which I think is already well known to the Committee, is the very remarkable and most encouraging decrease in the death rate among children. That, I think, is the proudest achievement of this country and the health services in the last half century. Since 1910, the infant mortality rate has been halved. That is a marvellous achievement for the new welfare services conducted with so much efficiency by the local authorities and by the medical profession throughout the country.
Turning from mortality to morbidity I find no evidence of increased morbidity in the country as a whole. In the case of such diseases as pneumonia and bronchitis the morbidity statistics are going down. But most important of all, as a barometer of health and nutrition, is tuberculosis, and there, the figures show that the death rate per million from tuberculosis in all its forms fell in 1932 to 838 from 896 in 1931. I am glad to say, owing again to the success of these great health services for children to which so much attention has been paid by us and by the local authorities in the last two years, there is a particularly marked fall in the incidence and mortality of non-pulmonary tuberculosis which is the child's particular form of the disease.
Now we come to a circumstance which is less favourable. I refer to maternal mortality and while our statistics of infant mortality may be our pride, those of our maternal mortality are undoubtedly matter for dissatisfaction. Certainly we are not content with them. Let me point out, in order to bring this matter into its proper relation with the general national health and into its proper relation with the nutrition question, that maternal mortality is due to particular diseases and disorders which affect the mother and child at the time of birth. I am sorry to say that the mortality last year was 4.11 and that this year it is a trifle bigger, namely 4.21. What is the significance of that figure? It is not that there has been any marked increase. It is that year in and year out
it has not been going down to our satisfaction. How are we to deal with that position? The first part of the work must be the better education of the mother and of the midwife. The experience of all people in close touch with this question tells us that that is where effort is needed. If we educate the mother, if we get a better standard among midwives, then we shall have done the very best work we can do for the purpose of removing this blot from our health escutcheon. In the meantime, we continue constant pressure upon the local authorities to raise the standard of the maternity services. That, I look upon as being absolutely in accord with sane economy because it is economising a national asset. Health and welfare in childhood and safety for the family-there are no greater national assets than those. I am delighted to feel that the number of infant welfare centres is increasing and I am particularly glad that ante-natal clinics are conspicuously increasing. They have increased by 250 in 1931 and 1932. That is a real advance of the troops in this warfare against ill-health.
I propose now to give the Committee some information on a matter in which, I am confident, they are particularly interested. I propose to give first hand evidence of medical officers of health and regional medical officers on the actual state of the physical health of the country, and of the unemployed in its special relation to this question of malnutrition. I have seen all the reports and a general summary of all those reports is that the health of the country as a whole is normal in spite of the depression. I have good reports in particular from London, Lancashire, Birmingham, Liverpool and the North Riding. Are all the reports good? Certainly not. It is impossible in such times as these to draw a picture which is wholly bright. I get bad reports from certain areas which need the greatest care and attention but I want to give the Committee a general view of the reports on the country as a whole and I think the extracts which follow are fair. The County Medical Officer of Lancashire, which is certainly an important area for evidence of this kind, reports:
Unemployment has been a prominent feature of the year and many medical
officers, particularly where the cotton industry is the main source of employment, refer to the effect of the conditions on the inhabitants.
That is what would be expected. The report continues:
But there does not appear to be any direct evidence that these conditions have seriously affected the health of the community.
As regards children, I take the report from a not less important area. The health report of the London County Council states:
Inquiries made during the year show that no noticeable change has taken place in the condition of the children and that in London there has certainly not been any perceptible decline in the children's condition.
Those are fair samples. On the other hand, I get bad reports from some parts of the country, and when I do, those bad reports are usually attributed to some specific local cause of bad health. A fair specimen is Jarrow, whose circumstances are so well known to students of depressed areas—Jarrow, labouring under such formidable conditions of unemployment, depending almost on a single trade, almost indeed on a single works. This is the report of the Medical Officer of Health for Jarrow:
Long depression and unemployment have undoubtedly had an adverse effect on the health of the inhabitants. This is particularly noticeable in regard to overcrowding, which is a potent factor in our high mortality rate and in our pneumonia and tuberculosis death rate.
Here, where you have a bad area, where health is not what it should be, you come back to that evil upon which we are engaged in our general attack, the evil of the slums. Let us remove it, so that our next reports from Jarrow may have a more encouraging turn.
Now I turn to the regional medical officers, who have such close contacts with the actual health of the community. I have made inquiries from them, and taking the country as a whole, judging from the evidence of the regional medical officers of health, it is possible to say that there is very little or no direct evidence of ill-health as attributable to malnutrition. Localised areas show some harmful effects, and I will mention them, because they need attention from the local authorities concerned. They are West Cumberland, Tyneside, the Hartlepools, Sunderland, and some of the
mining areas. The regional medical officers' reports give clear evidence that the anxiety and trouble of the population due to unemployment all over the country have had some effect on the mental health of the country, and I give what I think is a fair specimen of the regional medical officers' reports, which comes in from a great industrial district, South Wales, where the regional medical officer says:
Unemployment has tended to produce a deterioration in the general condition of male workers, who were formerly in regular employment. There is a lack of muscular tone and an altered mental outlook. Men who have been accustomed to work regularly become very depressed. In my view there is no increase in malnutrition.
There, I believe, is a fair sample of the general evidence from the country as a whole as to the present state of the health of the country. There is no direct evidence of any bad effects or actual physical disease from malnutrition.
I will say one word which deserves the attention of local authorities. When you are looking for a place in the family where malnutrition will show itself, and where the bad effects of unemployment and depression will show themselves, look at the mother, look at the woman. It is impossible and beyond the power of any man to prevent a mother from depriving herself for the sake of her children. It always has beet done and always will be done, but it does place upon us the special responsibility, at such times as these, of watching the health of that part of the population, the mothers of the country, and making sure that no general evidence as regards the health of the country as a whole blinds us to the fact that there may be difficulties turning up with regard to the nutrition of this particular class of the population.
How shall we summarise this inquiry of which I have been giving an account to the Committee? I should say that the exceedingly low sickness and death-rates of the country in 1931 and 1932 are evidence that deserves attention. Then there are these medical reports which I have received, and of which I have given an account to the Committee, and there is as well the experience of my own medical officers at the Ministry of Health that supports what I have been saying. I think we may come to the conclusion that there is at present no available medical evidence of any general increase
in physical impairment, sickness, or mortality as a result of the economic depression or unemployment. At first sight this deduction is surprising and it requires constant care to be sure that it remains true. It is common knowledge that there is a great deal of social and domestic distress, but the public medical services for the insured, for maternity, for infant welfare, for the school child, for general and special nursing and health visitation, for the treatment of special diseases, such as tuberculosis-all these have proved, in these bad times, of absolutely inestimable service to the country.
It must not be overlooked, either, that public assistance, maternity and child welfare centres, and school medical services throughout the country provide large quantities of supplementary food. I have a figure here showing that in 1931, for instance—the last available year—48,000,000 school meals were served to children by the local education authorities, and an additional 1,000,000 children received supplementary milk. There is this to be said that from almost every area the same explanatory answer is forthcoming, namely, that public assistance, health and unemployment insurance, and the far-reaching public health services have proved the defence of the nation in bad times.
There is one other matter to which I would refer, and that is the other aspect of the administration of local government services, the aspect of economy. Economy is not an abstract matter in itself, but is one aspect of efficiency, and I recognise that in these difficult times the local authorities have fully realised that it is their duty and obligation to their ratepayers and the country as a whole to see that they get full value for every pound of rate money which they spend. There has been a most careful survey on their part of the objects of outlay and the efficiency of their services, which has resulted in useful and important economies in local government services, without any sacrifice of efficiency, and it has been, of course, and will continue to be, the aim and object of the Ministry of Health to encourage this effort of efficiency and economy on the part of the local authorities.
I am glad to say that there has been a positive result from that effort of economy
on the part of the local authorities reflected in the actual rates. The average rate collection per head was in 1930-31 £3 15s., but in 1932-33, two years afterwards—the last available year—the local authorities had got it down to £3 12s and, what is more, they had done that in spite of the mounting cost of public assistance owing to the increase of unemployment, which, as we know, has a very serious effect on the rates in many areas. That is a remarkable achievement. I recognise the good work which has been done on behalf of economy by the Committee of which my hon. Friend the Member for Richmond was chairman. He does himself and the Government an injustice when, as yesterday, he said that no notice was taken of his report. On the contrary, very full notice was taken of it, and the vast majority of his recommendations were at once commended in the Circular which I addressed to the local authorities.
I come to the end of the review of what I think is most in the forefront of the nation's consciousness in relation to the services that come in my particular view. I do not think that I shall have said anything which will give any ground for that all too familiar charge of complacency. Whenever anyone says anything which is favourable, the charge is that of complacency, and when one says anything unfavourable, it is defeatism and pessimism. The adjectives that are applied to a Minister matter very little, however. What matters is that he should keep his judgment sane and sound and his activities right on such vital matters as those which which I have dealt, and that the country should be in possession of the facts, of all the facts, and nothing but the facts. I have tried to lay these matters before the Committee today, and I believe that the Committee will come to the conclusion that they can support the action that has been taken in this regard by His Majesty's Government.

11.57 a.m.

Mr. GREENWOOD: The Committee has listened with great interest to the speech of the right hon. Gentleman. This is an opportunity for the Minister to review what his Department has done. It is, in my view, although perhaps in this matter I have a prejudiced mind,
one of the greatest of our State Departments. It is indeed the most human of all Departments, for the Ministry touches the lives of our people at so many points from before birth to after death. It is good to know that during these times of economy the right hon. Gentleman is planning ahead, and what he had to say about the measures he has taken with regard to hospitals and town and country planning will meet with the general approval of the House.
He dealt with the three great elements of human welfare—shelter, food and disease. It did not strike me that what he had to say about housing was particularly optimistic. The impression that all the figures he gave conveyed to my mind was that he was just keeping the wolf at bay. There is no development of housing activity, but we are just holding our own. Indeed, we are hardly holding our own. It seems to be a matter for pride on the part of the Minister that there has been no falling off in the building of houses. The figures that he quoted did not carry us very far. The fact that there has been in the early months of this year a decline of 131,000 in the unemployed in the building trade is not in itself any proof that all those people are re-employed in the building industry, and certainly it cannot be taken for granted that all these men are employed on house building. If there be this enormous increase of house-building labour, then clearly there ought to have been a much larger output of houses than apparently has been the case.
The £34,000,000 worth of plans of all kinds approved, as the Minister admitted, include all kinds of buildings, and by far the greater part would be buildings in no way connected with shelter and with the housing problem. As the result of the return to private enterprise in building, which was rapidly going to help us to solve the problem, after a year in which we had three months of the new policy the number of houses of all kinds built is less by 300 than it was the year before. If the right hon. Gentleman is satisfied with that, he is far too easily satisfied. It is, of course, as he pointed out, a little too early for him to say anything about actual achievement with regard to the campaign against slums. In that campaign he will carry with him the good wishes of everybody on all sides of the Committee. Obviously, nobody
could be more delighted than I should be if the right hon. Gentleman made a success of an Act which I had the honour of placing on the Statute Book, and I hope that, if the right hon. Gentleman has to present the Estimates next year, he will be able to show us a considerable volume of actual achievement in the realm of slum clearance.
As regards the second point with which the Minister has dealt, that of food and nutrition, he made a very guarded statement. It was a statement which was eminently fair on the basis of the evidence that he has, and the most that he could say at the end was that at present there is no available medical evidence that the long-continued trade depression has impaired the health of the people. He has been driven to admit, however, that there are areas where the reports are not so favourable. Let us consider the actual economic facts. Only a few days ago there was published a report by the Sheffield Social Service Council, which shows that one-fifth of the working-class households in Sheffield are living below or on the margin of the poverty line. Two out of every five families are living in comparatively poor circumstances, half on or below the poverty line, and the other half within a close distance of it. The report says: that had it not been for various forms of social income, insurance benefits and pensions, but leaving public assistance and charity out of account, nearly two-thirds of the working-class population would have been below the poverty line. What is their poverty line? It is what is described as a rock-bottom standard. It is not a generous standard of human existence. It is a rock-bottom poverty standard. The report says that before a family was held to be in poverty its resources available, if pooled and intelligently used, had to be insufficient to cover its minimum requirements in respect of rent, food, clothing, heat, light and household utensils, without any allowance for recreation, newspapers, tobacco, holidays, sickness or savings. That is a very low minimum standard. In this large City of Sheffield, but for the social provision made now, two-thirds of the working-class families would fall below, and even with the provision that is made one-quarter of the families do actually fall below, the bed-rock poverty standard. Where people are living below or
trembling on the very edge of the poverty line, although it may not be immediately reflected in an increase in the morbidity rate or the death rate, it is quite clear that in course of time that grinding poverty and shortage of the necessities of life will tell a sorry tale. My view is that it is yet too early to reap the full results of this economy campaign and the poverty existing among large numbers of our people. Year by year Ministers of Health come forward and tell us, almost unvaryingly, that the infant mortality rate has gone down, that the general death rate is down again, and one Minister after another pats himself and his predecessor in that great Department on the back. We are entitled to expect that these rates will continue to decline, and the fact that they are doing so during this time of depression is satisfactory, but there is no proof that they might not have fallen a little more, perhaps, if economic circumstances had not been as hard as they have been.
It is reasonable to expect that the poverty in the country will lead to a higher disease rate, and certainly to a reduction in the vitality of our people. Within the last two days there has been published a report-part of an international inquiry on unemployment and the child-of an inquiry conducted by the "Save the Children Fund." It is a very balanced document, not highly coloured, but it does draw attention to some striking facts in Sir George Newman's Report on the health of the school child. In 1925 the incidence of malnutrition per thousand inspections was 9.5, in 1930 it was 10.6, in 1931 it was 11.2. Those are not the figures of the investigators, but those given by Sir George Newman, the Principal Medical Officer to the Board of Education. They show that in recent years there is an increasing amount of malnutrition among children, and this Report itself goes to show from inquiries made in many parts of the country—not all of them from medical sources—that while admittedly large numbers do not show any sign of malnutrition there are numbers in some of the most hardly-hit areas whose future is being imperilled because of malnutrition. It is possible to draw attention to other inquiries and the reports of certain school medical officers and medical officers of health where there is some
evidence—it may not be general and apply to the whole country—that the poorest of our people and those in the most unfortunate economic circumstances are beginning to feel the physical strain of the conditions under which they live.
At the end of his speech the right hon. Gentleman referred to economy, which he dignified by describing it as one aspect of efficiency. In so far as it is that, economy will always meet with the approval of reasonable people, but if economy is cutting into the bone of the social services that is not an aspect of efficiency but a source of subsequent social inefficiency. I think it is reasonable, in view of the Minister's own statement, to come to the conclusion that his policy has been successful. That policy goes back to the famous circular 1,332 published by the Ministry of Health in September, 1931. They allowed no grass to grow under their feet; they took very early action, urging the local authorities to pay special regard, in the interests of economy, to whether particular services were or not likely to be remunerative either at once or in the near future, end whether they were required on urgent grounds of public health or other grounds of similar public urgency. That was not merely an invitation to the local authorities, but the exercise of pressure on them, to curtail their social services, and did make it almost impossible-and this is extremely important, and perhaps one of the worst consequences of that legislation-for the normal rate of growth of those services to be maintained. Quite clearly we are still a long distance from having the social services which, in my view, the nation needs, and any stoppage of their development during a period of economy is a net national loss.
The right hon. Gentleman has told us that the amount of rates collected per head has fallen since the National Government took office. He calls it a remarkable achievement. Indeed it is. What has happened I If the total of rates collected has fallen and a larger amount is being spent under the Poor Law—which is the case—it follows that substantially less is being spent on the other services. The explanation may be that there was so
much extravagance that much dead wood could be cut out and still leave the social services intact. The only other possible explanation is that this very substantial reduction of expenditure—making allowance for the increase in Poor Law expenditure—on the other social services has been secured by the curtailment of those services. I do not myself believe, with this enormous increase in Poor Law expenditure and the shrinkage in the total amount of rates, that that saving on the social services can be got honestly. If it is true that there has been so much extravagant and unnecessary expenditure it is a gross reflection on the Ministry of Health, the Board of Education and the Departments in close relationship with them. It is a great reflection on our local administrators, who have to face the ratepayers year by year—

Mr. HOLFORD KNIGHT: Not the Aldermen, unfortunately.

Mr. GREENWOOD: Most of them have to face their local ratepayers year by year or every three years. While there may be, here and there, cases of bad end extravagant administration, there is not room for a very large cut in the social services on that ground Malone. Therefore, one is driven to the conclusion that the services have been curtailed and necessary developments postponed or indefinitely suspended. It is during times like these, when individual incomes shrink, and when hardship increases in the country, that the social services become more important. I have quoted the case of Sheffield. Sheffield would be a derelict city today if it were not for the help given by the social services. It may not be a palatable fact, but it is nevertheless true that the difference between a quarter of the people on the poverty line and two-thirds on the poverty line, is due to the fact that there are social services available for them. Therefore, in times like these the social services have an importance far greater than they have in normal times. It may be true that services here and there have increased. Prenatal clinics I am glad to see have increased, but, in so far as any desirable services have increased, the increase has been by the curtailment of some other services.
We are left, therefore, after the right hon. Gentleman's survey of the situation,
with the fact that the physical deterioration of the people, though it may not be obvious everyhere, is admittedly a serious danger. That, at least, is admitted. As a result of the Government's economy policy, we have succeeded in two years in a curtailment of the social services which is bound to have tragic social reactions later. The last consideration, I think, can be linked with the first, and the right hon. Gentleman might now reverse the engine, and, instead of pursuing his policy of economy in the social services, give those services a chance to develop as an important contributing factor in avoiding any possibility of the physical deterioration of our people during this time of economic trouble.

12.18 p.m.

Lord EUSTACE PERCY: When the right hon. Gentleman the Member for Wakefield (Mr. Greenwood), in the earlier part of his speech, said "Let us consider the economic facts," I was as alarmed as I usually am when I hear anybody make a remark of that kind. Sure enough, he followed it up by a succession of statements about economics which are demonstrably untrue. He began by a peculiar statement quoted from the Sheffield social survey, that if it had not been for various classes of social service, a much larger part of the population—I think double the population—I would have been below the poverty line. How does he know? How does the Sheffield social survey know? Surely, as a social economist, the right hon. Gentleman knows that if there is one thing certain at the present time, it is that social services financed by taxation have a. tendency to depress wages. I have heard that stated from those Benches often and often. To say that if it had not been for the social services—I of course, that is not what the social survey of Sheffield meant; it was what the right hon. Gentleman meant-the wages of the population of Sheffield would not have been higher is an entirely unjustifiable remark.
The right hon. Gentleman then went on to say—I and I would ask his special attention to this—I that we have a right to expect that the mortality rates will decrease. Surely he knows that we all have a right to expect that in the immediate future mortality rates will in-
crease. That is bound to happen with a declining birth rate and a falling death rate. Therefore, do not let us have the right hon. Gentleman coming along two years hence and saying that the increase in mortality rates is due to the economic policy of the Government. Finally, he based his concluding argument on the assumption that the 3s. per head of population by which rates, according to the Minister, have gone down, meant a, reduction of 3s. per head of the population in the social services. If he knows anything of the figures of expenditure of local authorities on education and public health, he knows that that is not the case. That reduction is not a reduction of expenditure on social services, and he knows that nothing remotely like that sum has been taken off the social services in the last two or three years. Therefore, the whole of that part of his argument falls to the ground. I hope that next time he invites us to consider the economic facts, he will give us a few statements that will at least bear cursory examination as statements of facts.
My object in rising, however, was not to engage in controversy of that kind, but to ask the Committee to consider for five minutes another subject, which was briefly touched on by my right hon. Friend the Minister of Health, namely, town planning. The Minister of Health laid emphasis on the necessity in his Department of foresight, and he gave town planning as one of the major instances of that virtue of foresight. So far as my right hon. Friend himself is concerned, I am perfectly prepared to agree. Long before he became Minister he was distinguished for his great interest in the problem of town planning, and especially the problem of the preservation of rural amenities, and I should be the last to deny him the title of a far-sighted person in that respect. But are the proceedings of the local authorities in regard to town planning, as they are going on all over the country at the present moment, an instance of real foresight, or are they an instance of the ambitious planning of a whole country piecemeal, not according to any informed or inspired estimate as to the future, but according to the current passing fashions of thought? I think that when one looks at such information as is published by the Ministry,
or information frown other sources as to the town planning schemes of local authorities, one cannot but be impressed by one or two features of those schemes, in the first place, the complete absence of any relation between town planning and slum clearance.
That is one of the gravest defects, if I may say so, in the whole of this Government's policy, and the same, of course, applies to all previous Governments. One of the gravest defects in our national arrangements for town planning and slum clearance is that the two are wholly out of relation to each other. A local authority which follows the Minister's advice, as we all hope every local authority will follow it, and produces a plan for the clearance of slums, can now get approval from the Minister fairly easily. Again, a local authority desiring an improvement scheme, the widening of a main thoroughfare in the town, or whatever it may be, can by some means get the approval of the Minister of Health. Suppose that a local authority tries to do the two things together and, as every far-sighted local authority should, to utilise its slum clearance as an opportunity for improving the general lay-out and amenity of the town, in so far as the particular area is affected, they will have to go through a long and complicated procedure—I at least they believe that they will—I arising from the fact that they are trying to do the two things at once, and that half of the improvement scheme has to be put through under one procedure and the slum clearance half under another. There are certain difficulties which the local authorities themselves have to face in. combining two schemes of that kind and into which I will not enter here. That is the first thing that strikes one.
The second thing that strikes one is that all local authorities are providing for residential development on a large scale. The whole idea of planning is to spread houses out more and more, on the whole as thinly as possible, and, moreover, in so far as working-class development is concerned, to build in all areas more or less the same traditional type of workman's cottage as we have been used to in the past. In doing so, the local authorities are providing for residential development on a scale more than sufficient for a population double or treble
to the present estimates, after which it will probably decline between 1,000,000 and 2,000,000 in the next 20 years. The building of this type of cottage, to which we have all become accustomed, is our national habit, but that national habit is changing in those parts of the population where habits most easily change, namely, that part of the population which has rather larger resources than the other part, and whose resources change more.
Anyone looking at recent developments in London must be struck by the fact that the upper class and the upper middle-class, whose needs are catered for by private development, are living more and more in great blocks of flats, while the workmen whose needs are catered for—or not catered for—by local authorities, still, insist, on the whole, on having the old type of cottage provided for them. To anyone who suggested building tenements on a large scale, many hon. Members who accurately represent the popular feeling, would say: "No, we demand the old type of house." It is a peculiar contrast, that those classes of the population who are supposed to be able to dictate the kind of building which shall be erected by private enterprise, are moving in a new direction which one would have thought far more suited to reasoned planning for the future, while local authorities, on behalf of the great mass of the population say: "We will continue planning on the old, old ideas to which people have been used for the last 50 years." That is not far sight.
Finally, you get this third characteristic of town-planning schemes, that even the smallest and most rural authority is providing for an industrial zone. The amount of industry which is being provided for by rural and district authorities, or by joint planning authorities in rural areas, would be enough to supply this country and the whole world with commodities. The whole conception of the distribution of industry in future is out of all relation to the probability. I am not being unreasonable. I do not for a moment complain that a local authority like Dorking, as badly placed as any local authority could be for the purpose of industry, should say: "If by chance an in-
dustry should want to settle down here it shall settle in this small industrial zone," but in that way we are apt to get an excess of industrial zones over all possible needs of industry. If you look at the character of schemes throughout the country, you will see that they are planned on precautionary considerations of that kind. Almost every local authority thinks it necessary to provide for an industrial zone. Many of them are correspondingly taking active steps to advertise their areas for future industrial development. I am told, according to the propaganda issued by the council concerned, that Lidlington in Bedfordshire is the future industrial centre of England.
That piecemeal or local patriotism, and that conception of town planning, was precisely the situation which the Government sought to meet in providing for joint town-planning authorities. There are two sorts of joint town-planning authority—advisory joint bodies and executive joint bodies. The executive joint bodies are only executive in preparing what I think is called the operative plan. Some perfectly reasonable logrolling goes on in a committee of that kind—every constituent authority wants its bit of industrial development, and so on, and when the plan is prepared and the maps have been drawn, the tendency is, even if the committee remains a standing committee for every individual authority to go home and make a nice little pillow of the pile of maps that has been drawn up and to go to sleep upon them. That is not far-sighted planning. It is impossible at the present moment to draw up a permanent plan of the future development of the country; the factors introduced by the change in the course of population are such that most of the plans which you can draw up now will not, in 10 or 15 years' time, be worth the paper on which they are written.
What you want in town-planning is continuous administration, and you have made no adequate provision of that kind in regard to regional planning. You have no central direction in planning. Central direction in planning is a matter of research and advice, for more than administration, and an administrative department like the Ministry of Health cannot hope to be able to control town-planning in the way in which it ought to be con-
trolled. You need to offer to all your regional town-planning authorities advice based upon expert research in population statistics in various branches of economics, as well as in architecture and in the science of planning. You need a central ad hoc body—an advisory body, not a, departmental body—to try, day by day and year by year, to bring the various plans into some relation with the growing knowledge as to the probable future development of the country, the distribution of industry and the course of the population.
I have ventured to trouble the Committee with these views because really this is the moment for planning ahead in that way. We are at the present moment merely laying a flattering unction to our souls in saying that we are planning the country for the future. We are doing nothing of the kind. We have not made any provision except a provision for the perpetuation of that kind of current local fashion which is always so prominently in the minds of administrators, local or central. We have taken the feeling of the population, we have taken the sort of general sentiment of the population, the sort of current talk about what the future is going to be, and we are merely making a plan, not on a considered estimate of the future, but on the mood of the present. A drastic reform of our whole present methods of procedure will be necessary if we are to deal with the accumulating problems which are coming upon us, and, above all, the great problem of the replanning of the distressed areas. That will not be done by the mere slum clearance of a place like Jarrow; it must be done by a comprehensive replanning of the whole of an area like Tyneside.

12.37 p.m.

Mr. DINGLE FOOT: I hope it will not be thought presumptuous for a representative of a Scottish constituency to intervene for a few moments in a debate of this character. I can only suggest, if hon. Members do resent my intervention, that they must regard my remarks as a kind of revenge for the frequent incursions into Scottish debates of the hon. Member for Torquay (Mr. C. Williams). The matter that I desire to raise is one which affects both kingdoms in the same way. The Minister of Health has said that in affairs of national health we must always
be going out to meet our difficulties. I want to suggest that his department ought now to be going out to meet the difficulties which will arise at the end of this year, when a large number of persons who have been unemployed for from 2½ to 3 years will lose their entitlement to medical benefit, and to ask whether it is too late for there to be some reconsideration of this question by the Government, because it is being regarded with growing apprehension in all parts of the country.
A most difficult situation is likely to arise on the 31st December of this year and shortly afterwards, because a great many of those who are losing their entitlement to medical benefit will continue to go for treatment to the panel doctors whom they have been consulting for a considerable time, and the panel doctors will be put in a rather difficult position, because it is always difficult for a doctor to refuse treatment to one of his own patients. The change which is to take place at the end of this year will not re present any substantial economy; it will not mean a saving in expenditure, but simply a transfer of burdens from national to local shoulders. It will mean that, instead of the cost of medical treatment for these people being borne by the National Health Insurance Fund, it will have to be borne by public assistance funds, and it is bound to happen that the principal burden in respect of these unemployed persons—I do not know what their number is, but I believe it is about 100,000—will fall upon the depressed areas, where, of course, prolonged unemployment has been most common.
It is rather remarkable that, while only yesterday we were discussing ways and means of relieving the burden on the depressed areas, and in June we endeavoured to relieve some of their burdens, at the end of December, we are proposing to cast fresh burdens upon them. Can the Parliamentary Secretary tell the Committee whether the representations which have been made from many quarters, both in the House and outside, are going to receive reconsideration by the Government? This is not the first time the matter has been raised. It was raised by a number of Members on the 22nd of last month, in the Debate on the Estimates of the Department of Health
for Scotland, and a reply was given by the Under-Secretary in the course of which he said:
It is a question of whether by administrative means—legislative means could not be discussed in this Debate—the intended withdrawal of medical benefits, other than cash benefits, to those who have been unemployed for a certain period can be avoided. I cannot say more on that point than this, that while it may be possible by some administrative manipulation to do it—and I am not confident that it is possible—to take such action would require the consideration of the Cabinet, because it would represent an alteration of policy from the 1932 Act. It is not for me in this Debate to make statements as to alterations in Cabinet policy, but I am sure that what has been said will be added to the representations which we have received "—
these are the words to which I desire to direct special attention—
and the fact that the hon. Member has drawn attention to it in this Debate will mean that the question will come before those who are responsible for the policy of this country."—[OFFICIAL REPORT, 22nd June, 1933; col. 1021, Vol. 279]
That may not be a definite commitment, but I submit that anyone reading or listening to that speech would have understood that the question was again going to be brought before the Cabinet for reconsideration; and I was rather amazed at the beginning of the week, when, to a question which I put to the Secretary of State for Scotland on this subject, I receive the following reply:
My right hon. Friend has carefully considered the representations referred to. The possibility of extending the title to medical benefit of these persons beyond the end of the present year was fully discussed when the amending National Health Insurance Bill of last year was before Parliament, and it is not proposed to reopen the question." —[OFFICIAL REPORT, 4th July, 1933; cols. 147-8, Vol. 280.]
On the face of it there seems to be some contradiction between these two statements, and I would like to ask whether the Government will consider the many representations that are being made to them, both in Scotland and in England, and not only in the House of Commons. but from many quarters outside it.
It may be said that this matter was decided when we passed the National Health Insurance Act of last year. Most of us voted for that Measure, and, of course, we cannot escape, nor do we wish to escape, the responsibility for the vote that we gave on that occasion. I quite
agree that, if you have a system of insurance, insurance benefits must come to an end at some time; otherwise the principle of insurance would be destroyed; and there must be some kind of relation between the premiums paid and the benefits received. I am not asking the Government to go back upon what they did with regard to the National Health Insurance Fund in the Act of last year. But, because a man passes out of an insurance scheme, that does not necessarily mean that he ought to be thrown upon public assistance. I suggest that the Ministry of Health might consider taking a leaf out of the book of the Ministry of Labour, and that we might draw a comparison between health insurance and unemployment insurance. After all, unemployment insurance in the last year or two has been put upon a much sounder footing from an actuarial point of view, and, when a man passes out of contractual insurance at the end of 26 weeks of unemployment, he is not thrown straight away upon the resources of local public assistance but passes into a transitional class and, if he survives the operation of the means test, he is able to get relief from the employment exchange in exactly the same way as before.
I do not know whether it is possible, but I wish there could be some kind of transitional arrangement in regard to health insurance also. A number of suggestions has been put before the Minister outside the House as to what might be done to meet the situation that will arise at the end of this year. If it is decided that the burden of the treatment of these people must be borne in future, not by the Health Insurance Fund or any national fund but by local public assistance funds, cannot some arrangement be come to between public assistance committees and health insurance committees whereby, instead of carrying the burden directly, the public assistance committees made some contribution to the health insurance committees so that these people, who otherwise will loss all their entitlement under health insurance to medical benefit, may continue to go to their own doctors and to receive treatment through the same machinery as before? I am not criticising the Act passed last year, but I think at that time this matter was not sufficiently appreciated. It may be that
some of us were over reluctant to criticise the Government of the day, but, as the matter is arousing a great deal of disquiet and apprehension in many parts of the country, particularly in the depressed areas, I think it is a matter that might very well be reconsidered.

12.48 p.m.

Mr. TEMPLE MORRIS: It is, perhaps, appropriate after the Committee has heard a voice from Scotland, that it should now hear a voice from Wales. A Debate of this sort, with such a wide range of subject matter under discussion, naturally gives Members a good opportunity of commenting and, indeed, if they desire it, criticising the work of the Department. The chief reason that has prompted me to intervene is to offer a humble but sincere word of congratulation to the Minister for the work of his Department in these very difficult times. There are very few Government Departments, except perhaps the Inland Revenue section of the Treasury, which are more dependent on the prosperity of the British people than the Ministry of Health. Health insurance and pensions depend to a large extent on the people's ability to contribute, and it must follow that, if you have unemployment which affects the contributions of the people, you have a Government Department with fewer contributions and, perhaps, more expenditure in meeting the very heavy claims upon it. Therefore, when a Government Department deserves a word of praise, one likes to hear it given so that those whom we represent can appreciate the work that is done.
I represent a City which has long since been virtually admitted to be the capital City of Wales. If any Swansea Members were present, they would probably rise in wrath at that declaration. There is no part of the country which has felt more the full force of trade depression than South Wales, and there is no section of the British people who have suffered more, and more bravely, than the people of South Wales. Trade depression has affected insurance there, and, in spite of the trouble and the depression, in spite of adverse decisions of the Ministry, perhaps proper so far as pension claims are concerned, one never hears a harsh criticism against the Welsh Board of Health. It speaks volumes for the efficiency of the able chairman who looks
after the Department. One hears a great many bad points made against South Wales so far as trade depression and unemployment are concerned, and it is looked upon as a somewhat black spot in view of these rather one-sided criticisms, but we must face facts. I am proud to say that we have no slums in Cardiff. Under the regime of the present Ministry people have been encouraged to go into housing schemes. The Great Western Railway Company have embarked on a tremendous scheme at their station at Cardiff and better roads are being made by the municipal authorities, and one must bear these points in mind when analysing the Welsh situation. I should like to say a word of grateful thanks to the right hon. Gentleman for visiting this area, as he did last September. His going down there and seeing things for himself has made people in South Wales a great deal more optimistic. It has given them a considerable amount of encouragement, and I am sure, if time and the pressure of business will allow him to go there again, he will have an equally enthusiastic reception.
There are three small points that I desire to place before the Committee, not in the sense of criticism but in the hope that they may be considered and, perhaps, put into performance. When an applicant for a pension is refused, he receives what is known as a statement from the Minister. It contains several typewritten pages. Would it not be advisable, for the sake of economy, rather than send out a long detailed history, which is more in the nature of a technical arbitration award, which it takes even a skilled lawyer's patience and concentration to understand, as we are dealing with poor people of only average education, to send a short epitome of the grounds of the refusal of the pension?
The second point is this: In the matter of contributory pensions referees are entitled to dispense and sometimes do dispense with a hearing. It might seem contradictory if, having said that the first point is one of economy to dispense with certain work, I now make a suggestion which might entail a little more work, but I hope that it is the exception rather than the rule when those referees dispense with a hearing. Anybody possessing a sense of fairness always goes away with
a feeling of satisfaction if his claim has been thoroughly heard and fully investigated. I am not suggesting, and I do not want it to be understood for a moment, that the referees under the Act are taking short cuts to decisions. But I ask that wherever possible, consistent with their duties as referees, the time at their disposal and the funds at the disposal of the Government Department, they do not dispense with any hearing.
My third administrative point is as follows. When an appeal comes before a referee for a pension or something of that description under the Ministry of Health, witnesses are sometimes referred to in the grounds of appeal of the applicant. The applicant may say, for the sake of example, "My late husband worked at such and such a place. He was employed from the 1st January to the 3rd March, and Mr. So-and-So, the manager of the works at which he was employed, is prepared to come forward and give evidence to that effect before the Appeal Tribunal." I am not suggesting that the Department do anything improper. They possibly interview this gentleman and take a statement from him, but the point I want to make is that it would be very much more satisfactory from the point of view of the applicant if the oral testimony of the witness was given in his presence before the referee and he could there and then ask him any question if he desired to do so. Because, as a famous judge once said, it is one thing to do justice, but, as well as doing justice, you want everyone to think and to feel that you have done justice.
My concluding observations relate to a point which I wish to put before the Minister of Health, because I feel sure that if there is anything he can do in this direction he will do it. I do not think that he has any power to do it, but tactful persuasion sometimes does a great deal in many walks and fields of life. Is it possible for the Minister to do something to persuade those in search of factory sites to get them near actual housing schemes National economy or national reconstruction or reorganisation, call it what you like, demands some sort of Government direction—not Government control—or Government persuasion. Is it the policy to open new districts or to develop old ones? Speaking as far as Wales is concerned there are many housing schemes. There
are suitable areas which are well provided with houses, with gas, light and water, and also schools. It would be a wonderful help if some gentle form of direction or persuasion could attract a factory site in those particular directions. I suggest that, rather than put your factory in an open space and afterwards have to put up houses, you should, if possible, put your factory where you have houses and can employ men near their homes. We probably might hear the cry: "We cannot come to South Wales; the rates are too high." The answer is that if you come to South Wales with your factories and give men employment the rates will automatically be lowered. I have made these few observations in no sense of criticism, but simply, I hope, as a constructive contribution to the Debate in which we are now engaged.

1.0 p.m.

Mr. TINKER: The Chairman has shown a wide discrimination in calling upon hon. Members. We have heard hon. and right hon. Members from Yorkshire, Hastings, Scotland and South Wales. The points which the hon. Member for East Cardiff (Mr. P. Morris) put in the latter part of his speech were very useful indeed, and I hope that the Department will take notice of them. The hon. Gentleman the Member for Dundee (Mr. Dingle Foot), I am reminded, was a supporter of the Government in regard to a number of the Measures which he now finds unpopular among his party. I do not know whether they have an idea that there is likely to be an early election, or whether the hon. Gentleman was finding fault with certain points because he wished to have them rectified. I would remind the hon. Member that he gave whole-hearted support to the Government last year in regard to the insurance scheme. We on these benches pointed out anomalies such as the hon. Member has brought forward this morning, and yet we did not get any support from the Liberal benches. At that time it was thought that the National Government could do no wrong, and everything they brought forward was supported by the Members of the Pact. I would advise the hon. Member and his friends not to cry out too early against the National Government. They should give the Government the support to which they are entitled from his party because they
obtained their seats largely on the strength of supporting the National Government. The hon. Member would not now be the senior Member for Dundee if he had not come forward as a National candidate, and therefore he is morally bound, whatever he may think upon these matters, to keep quiet for the time being.

Mr. DINGLE FOOT: It was a different Government then. Since then the virtue has gone out of it.

Mr. TINKER: I do not know about a different Government; it is the same National Government. The Parliamentary Secretary was a good Liberal at that time, and he may be so still, but he has not departed from the pledge which he gave to the National Government. He defends them on every occasion, and one admires a man who stands by his pledges. The right hon. Gentleman the Member for Hastings (Lord E. Percy) seems to have got into the habit of coming down on a Friday in order to speak from his lofty position opposite and give expression to his lofty ideas. He tried to tell us that the middle classes and some of the upper classes are getting a new type of dwelling, and gave an idea of what ought to be done. I should like to ask him if he is prepared to depart from the type of building which he occupies. The working man's idea of a home is similar to that of the highest in the land. He likes to have a. separate building and an adjoining garden. The idea of the block housing system has not got into the mind of the working classes, and I hope that it will not do so. It will ruin the whole of the English countryside if we have that sort of thing. I wish that the right hon. Gentleman the Member for Hastings had stayed in the Chamber, because he is one of those men I should like to get at if I had the opportunity. He would no doubt make a good dictator if he had the opportunity.
The Minister dealt with a subject which appealed to me very forcibly when he spoke about refuse heaps in and about London. He said that he was trying to get the London area to co-ordinate their efforts in order to prevent the unsightly growth of these refuse heaps. That is a very wise step, and I would suggest that he might turn his attention a little further than London. I should like to take him to the industrial north, where he might
use his influence to help us to bring about the removal of the unsightly heaps which are to be seen there, such as the chemical heaps round about Widnes and St. Helens. Those centres of activity have produced great wealth for the country, and one of the results has been the dumping of these great heaps of refuse. It would be a grand thing if they could be removed.
In the mining areas there are great numbers of dirt heaps. The colliery owners have put their dumps everywhere. It has been a question of making wealth as fast as they could, having no regard to the countryside, making it unsightly, and then going away and leaving the refuse heaps there. Not only are the heaps unsightly, but they are unhealthy. The beat and pressure cause spontaneous combustion, and huge fires result. The inhabitants in the vicinity of these refuse heaps often find conditions almost unbearable on account of the sulphur fumes which arise from the heaps. I hope that when the Minister of Health is considering his town-planning in order to make places more habitable for the people he will bear these facts in mind. He passed through Lancashire rather hurriedly on his recent visit to the north. I know he cannot devote very much time to any particular part of the country, but if during the coming recess the right hon. Gentleman or the Parliamentary Secretary could go round the industrial centres of Lancashire and Yorkshire and see what is happening, they would be impressed with the conditions which I have attempted to describe.
The discussion on the Vote enables us to enlarge upon subjects which we have raised by way of questions to the Minister. On the 13th June I put a question to the President of the Board of Trade with regard to timber, and I was a little worried that it was answered by the Parliamentary Secretary to the Ministry of Health. The question related to the cost of timber having increased because of the Russian embargo. I had information from my constituency, where they are very keen on house building, that the cost of the timber in the new municipal houses has been increased in consequence of the Russian embargo. The Parliamentary Secretary was hardly fair in his reply. He said that the cost of the woodwork in a house of £350 value
was about £30, and as the rise in the cost of timber was very slight it would have very little effect on the building of houses. I sent the reply to the surveyor for the municipality in my district together with certain figures supplied to me, and he replied that the figure as to the cost of timber in a house was correct, but that the cost of timber had gone up by five to six per cent. since the Russian embargo has been put on, which meant that the timber required for the houses in question would have to bear the extra cost.
The Minister of Health has dealt with the question of housing to-day, but I cannot say that I am altogether satisfied with this statement. The figures which he has given as to the number of houses in course of and in preparation for building will not bear the same favourable comparison next year, because a number of municipalities have hurried on their housing programmes this year in order to get the subsidy, and those figures are included in those quoted by the Minister to-day. I am afraid that the figures 12 months hence will not bear so favourable a comparison. There are several points which I should like to raise in connection with the National Health Insurance and Contributory Pensions Act, which was passed last year. I agree with those hon. Members who have made complaints with respect to this Act, because I find wherever I go a, lot of feeling about the Act. People do not feel sure of their position. They do not know who will get the benefit and who will be excluded. I should like the Parliamentary Secretary to make the position clear about the healthy person, and also in regard to those people who are under 60 years of age and those who have just turned 60 years. On the Second Reading of the Bill the Minister of Health said:
I propose one alteration which, although it may meet a minor point, is of some importance. Hon. Members know that if a man arrives at the age of 60, after that, if he is out of work, he is still in insurance for pension rights up to the age of 65, and he continues in insurance up to 65 in order to secure the old age pension. A man over 60 has not much chance of getting a job, and without the present system he would lose his pension rights. I find that the finance of the scheme under this Bill will allow me to make the age 58½ instead of 60, so that anybody who arrives at 58½ becoming unemployed will continue in insur-
ante until he has reached 65 if he remains unemployed."—[OFFICIAL REPORT, 11th May, 1932; col. 1942, Vol. 265.]
If a man had been unemployed for 12 months or longer up to reaching 58¼ years prior to that Bill becoming an Act of Parliament, will that man be put right for a pension, or does that provision mean that he must come out of employment after the Bill becomes operative. There is much agitation on this subject at every meeting that I attend. It is very notewothy how men's minds turn for protection when they are getting to old age. They are asking me frequently what this provision in the Act means. They ask me: "Am I all right, if I get my card made up at the Exchange. Shall I get my pension at 65"? I tell them: "If you are 60 now and get your card franked at the employment exchange, you are right for your pension at 65." Am I correct in that 1 If not, will the Minister make the point clear whether they will have to lose some rights because they are not that age at the present time? This morning we have been dealing with the protection of young life and I have not heard much about the protection of the old warriors and veterans. Life is made up of many things. We have been told that it consists of seven ages, and perhaps the most pitiful of all is the seventh. When a man has lost his usefulness that is the time when the State should see that he is protected. Last night the Parliamentary Secretary made a striking speech about people turning aside to do good work. I hope he will not be dismayed if he finds that there are at times people who do not fully appreciate what he attempts to do. Let him go on doing good work, if he thinks it is right; and bring whatever benefit he can to the aged at a time when it will be appreciated most.

1.16 p.m.

Mr. LOVAT-FRASER: I am always interested in the discussions on health estimates because they deal with one of the most important matters which can concern Parliament. The class in which I am interested, and who are covered by the work of the Ministry of Health, are Poor Law children. I have the honour, together with a very distinguished lady the widow of Canon Barnett of Whitechapel and Toynbee Hall, to be the Honorary Secretary of an association
which aims at promoting the welfare of Poor Law children, and I take every opportunity of doing what I can to further the work for children who are unbefriended; I will not say neglected. The way in which Poor Law children used to be dealt with is well known to all readers of the literature of the last century. They were either kept in the workhouse, mixing with the derelicts and failures of life, or herded into barrack-like buildings, which became centres of ill health and all sorts of evils, but during the latter part of the last century, and during the present century, these methods of dealing with Poor Law children have been gradually abandoned, and there has grown up a system of boarding them out with respectable people, housing them in scattered homes and in cottage homes.
That policy has been going on for a long time and one is very anxious that nothing should be done by the Ministry of Health which would be in any way a backward step. There are, I am sorry to say, cases in which I do not think that the Ministry of Health are quite following the progressive lines which have been adopted. One of the elementary rules with regard to Poor Law children is that they shall not live in workhouses. There is an Order of the Ministry of Health which provides that no child over the age of three years shall live longer than six weeks in a workhouse. Yet I am sorry to say that at the present time that rule is not being applied with the strictness I could wish. In June of last year there were 100 children in the workhouses of Dorsetshire who ought not to have been there, in November there were 60 in Cornwall, and at the end of the year over 60 in the Isle of Ely and nearly 80 in Devonshire. I press upon the Ministry of Health the importance of carrying out their own Order which forbids the retention of children over three years of age in workhouses. No effort should be spared to get those children who are now in workhouses out. Little children, whose eyes should be opening on the world with life and hope, ought not to mingle with mental defectives, and aged people, the wrecks and failures of life.
I am sorry that I have not the annual Report of the Ministry of Health for 1932-33. I believe it is in proof, but it shows a lack of efficiency that we should be discussing these Estimates when the
annual Report is in proof and not available. I find in the Report of the Ministry for 1931-32 that they are allowing children to be housed in workhouses, in buildings which have been workhouses, but which have ceased to be so. I read in the annual Report:
In one county a scheme for cottage homes came before the public assistance committee, but the need for economy induced them instead to adopt a proposal for the temporary adaptation and use of the institution in itself. In the special circumstances the Minister of Health is unable to urge the council to incur the greater expenditure at the present time, and he has agreed with a temporary use of the institution exclusively for children, and to similar adaptations of Poor Law institutions of other counties.
I do not know what these other institutions are, and I am not able to criticise the action of the Minister, but I say that to return on the score of economy, although it is important, to the grouping of children together in institutions is unsatisfactory and undesirable. As to the effect of grouping children into these big institutions let me quote an official statement made last year by an official of the London County Council:
It was officially stated that during certain months children in the Chase Farm school had on six different occasions to be excluded from the local elementary schools owing to the presence of infectious disease in the farm school.
That is thoroughly bad, and I appeal to the Minister, although there may be considerations of economy, not to put these children back into the old institutions and group them there in large numbers, with all the disadvantages which will follow. That is all I have to say about Poor Law children. I only ask the Minister to follow the policy that has been adopted for many years, not to go back upon it in the interest of economy, but see that these children get a training which will enable them to go out into the world and face it on equal terms with the happier child who has not had to resort to the Poor Law.

1.24 p.m.

Mr. BUCHANAN: I apologise to the Committee for not being present at the commencement of the Debate and also for intervening on the Estimates for an English Department, but my reason for doing so is that the question I wish to raise is no different in Scotland than it
is in England; it is exactly the same in both countries. I understand that other hon. Members have indicated their intention of raising the same issue. Some time ago this House passed an Act dealing with the pensions of large masses of working-people. We also passed an Act containing provisions that concern the health of the people, their medical benefits and maternity benefits. I am certain that when the House passed that Act large numbers of Members were not aware of the full effect of it. I do not know whether I do hon. Members a justice or an injustice, but I feel certain that if they had fully realised the way in which that Act was going to play havoc with great masses of very deserving people the House would not so readily have assented to the Act.
Recently the Insurance Committees in Scotland and some of those in England have been very much concerned about two or three aspects of the Act. One aspect is a matter of interest to approved societies and to insurance committees which, as the Parliamentary Secretary knows, contain representatives of the doctors, the insured population through their approved societies, and other interests, as well as persons appointed by the Minister. The insurance societies are very much concerned about large numbers of insured people who have to lose their medical rights. I ask the Minister whether he could not administratively take some action that would keep these people within the fold of insurance. 1When we passed the Act we thought that every man who had reached the age of 60 and who was within insurance had his pension rights safeguarded. That is what this House understood.
I hope I do not display too much egotism when I say that I know the Acts very well and take a keen interest in debates on them. When this Act was passed I made a speech to Labour people and those connected with my Union in order to explain it. I then thought that every one who was within insurance at the age of 60 was at least safe for pension rights. But what is the actual position? It is that the person must have reached the age of 58½ on the date when the last stamp was affixed. Take the case of a person who has reached the age of 60 and who has been unemployed for two years. His age at
the last affixing of a stamp was 58, not 58½, and the consequence is that he is "out." I do not want to do the Minister an injustice. I have read the Debates on this subject, and I know the right hon. Gentleman's case. But I am certain that every one in this House thought, when we passed the Act, that any insured man, when he reached the age of 60, was assured of pension rights. It is not the case.
I know that the Minister's reply will be something like this: "Yes, it is 60. We have a period, and that period dates back to 58½ from his sixtieth birthday, and that is the period on which we start working." I plead with the Minister in this matter. I wish I could raise the whole issue, but I cannot do so as it would involve legislation. In the fixing of the date the least the Minister can do—I am certain he has the power—is to make it sixty as at the date the Act was passed, if an approved society still has the man inside the insurance field. Since I raised this point men have written to me. I have particulars of one case, not from my own division but from outside London. It is the case of a man who was 57½ when he was last dismissed from his work. He is now about 61. He was never unemployed until he was 57½. But he has lost his pension rights and has to start to requalify. What makes this man's position more peculiar is that he has now started work. He has again to come in and qualify for his old age pension. His whole previous period of qualification, for 16 or 20 years, hardly counts in effect, because the Minister has ruled that the date of the last affixing of the stamps must be when a man is 58½. I hope the Minister will realise the shocking and terrible effect of the Act in cases like that.
Another point I want to make relates to the question of health. I think that the senior Member for Dundee (Mr. D. Foot) has raised the point. The Under-Secretary of State for Scotland, when replying to a Debate on the Scottish Health Estimates, stated that it was doubtful whether administratively the department could do anything to keep within the scope of health insurance people who lost their medical rights, but he went on to say that the Cabinet and the Government would possibly seriously consider the matter. Whatever can or cannot be done
administratively, I think that a fund could be created to keep these people within insurance. The Under-Secretary knows that a fund, called a reserve fund, was created, from which certain sums were allocated at the outset to insurance. A portion of that fund ought to be earmarked to keep within insurance those who are passing out of medical rights.
Yesterday we debated the needs of the distressed areas. I do not want to transgress by referring to yesterday's Debate, but I do not like the method of dealing with the £500,000, nor would I have liked the method if the amount had been £5,000,000. I would sooner relieve distressed areas by relieving them of the charge for the unemployed and the sick. I would prefer that the Government should pass decent Insurance Acts and other Acts to deal with this situation rather than give assistance of the kind proposed under the conditions which are to be imposed. But here we find that a serious charge is going to come on every public assistance committee. The Under Secretary said yesterday that, since 1012, the whole trend of policy of Governments of every complexion had been in the direction of relieving the public assistance committees to some extent by national action. It is, in the main, true that nearly every Government has done that by means of Pensions Acts and Insurance Acts of one kind or another until recently, but I say emphatically that the administration of this Act is a complete reversal of that position and its administrative effect to-day is that the public assistance committees will inevitably have large burdens placed upon them.
One could understand a position like this if it could be proved that the man affected had done something bad. But here we are saying to a man against whom there is nothing at all: "Because you have not stamps covering a certain period of time, you are not to have your own doctor and you must have recourse to the poor law for a doctor if you have no means of your own." That is very harsh and the Government ought to take steps to stop it. Almost all men and women grow up under one particular doctor. A doctor becomes almost part and parcel of a family whom he attends. We are forcing a man in these circumstances to go to a practitioner in whom he has no faith. That is not the practitioner's fault nor is it the man's
fault. The man has faith in the doctor to whom he is accustomed and faith in the doctor is essential if the man is to get better. I think it will be agreed that one of the most important things, if a doctor is to treat a case successfully, is that the patient should have faith in him. In this case we are not only compelling a man to go to a new doctor but we are compelling him to go to a Poor Law doctor. It is not the Poor Law doctor's fault if the man has not faith in him. He is probably just as capable as another doctor but there is not that feeling which there ought to be between doctor and patient.
There is also this consideration that a doctor who has been accustomed to attending a man starts with a great advantage. He knows his patient and can diagnose and tackle the ailment. It must also be said, in fairness to the medical profession, that in many cases if they had been associated with a man or a man's family for a long time they will do the work for nothing. It is not fair however that members of the medical profession should be asked to undertake a national burden as an individual burden. Finally, it may happen that a man under these conditions will not go to the poor law doctor at all. The medical side of the Ministry ought to take action in this matter. I would go as far as to say this. Some societies have surpluses and others have none but so keen am I on keeping these people within medical benefit that I think no hardship would be done to any society if a proportion of the surpluses were used for the purpose of keeping these people within the insurance limit.
I do not wish to transgress on matters in regard to which legislation may be required. We have heard denunciations of the means test and its far-reaching consequences, and certainly those cannot be under-estimated but in my view every week and month and year that this Act continues its devastating effects are proving even worse than those of the means test. Why should we take a decent miner who has reached the age of 59 or 60 and has been unemployed for two years and say to him: "You are to have no pension and your wife is to have no pension." Why should we cast him in his old age outside the limits of these provisions and refuse to allow him an
equal standing with his fellows? It is a shocking thing when we consider that the number affected by medical rights in Scotland is 20,000. That I understand from the Glasgow Borough Insurance Committees is the estimate, and I should say that the number in England would not be far short of 150,000 or it may be 200,000 peaple. I am basing that on the population figures for England as compared with Scotland, but even supposing that the number is only 50,000, remember that it is constantly increasing. It is growing like a snowball every year. Even if the unemployment figures fall by 100,000, say to 2,500,000, which is an optimistic estimate, the figure I have mentioned will continue to grow.
It is the Minister's bounden duty, as one who has the care of the health and well-being of the people, to see that this Act, bad and cruel as it is, is made no worse than this House meant it to be. I would even go the length of standing increased contributions sooner than see people losing their rights as they are doing now. I would take almost any step possible rather than sec decent old people cast adrift in this fashion as though the population of this country had no generosity, no kindness and no love for those who have given their best in the service of the State, where the effects of this Act are the worst and where they can least afford it. It is in the mining areas, in the shipbuilding and steel-making centres that the effects of this Act are the worst. You would think that those men and their womenfolk did not suffer enough, with their long years of deprivation of work, that we have to add the mean and contemptible blow of taking from them their health and pension rights. I trust that the Minister will take the necessary administrative steps to see at least that this cruel Act is administered no more harshly than it need be.

1.46 p.m.

Mr. SMEDLEY CROOKE: The speech to which we have listened from my hon. Friend the Member for Gorbals (Mr. Buchanan) is not only interesting, but it has shown, as his speeches generally do, that he is sincere in his advocacy of whatever change of administration or law will help, not only the poor people whom he represents, but the general class of the underfed and the down-and-out
throughout the country. I feel sure that the speech which we have heard from my right hon. Friend the Minister of Health will be read with great interest, not only by Members of the House, but by people all over the country. I am sure he does not expect or wish me to throw him any bouquets with regard to the work of his Department, but congratulations should be given to him on several of the matters to which he called attention this morning. He told us of the reduction in the unemployment, figures in the building trade, and that is very comforting news. He told us also that, although he expected fewer houses to be built during the transition period from the dropping of the subsidy to the Government's new scheme, more houses have been built in fact, and that also is a matter of congratulation. He told us that, although the work of his Department had been considerably increased, the administrative expense had been less.
These are all matters for congratulation, but there is one matter in the earlier part of his speech to which I wish particularly to allude. He told us that he had taken steps quite recently to secure co-ordination and standardisation of relief throughout the country. We have been working for that for some time, but I notice in the Press reports of the meeting of the Birmingham City Council held this week, that the report of the public assistance committee came before them, recommending a reduction in the relief rates for widows and orphans of one shilling per week. I wondered, when I listened to the Minister this morning, whether his recent action had in any way caused the public assistance committee in the City of Birmingham to take a course of that kind. I represent the poorest Division in the City of Birmingham. We cannot call ourselves a, distressed area, but my Division could easily call itself a distressed area, and I know the conditions under which the people there are living, because for some years I have had regularly weekly interview nights, when I get to know their conditions and their requirements, and I know that this cut which has been decided upon will have a materially bad effect upon those poor people.
I intended to put a question to my right hon. Friend about this matter, but as this Vote is before us to-day, I take
this opportunity of asking my right hon. Friend if he will make inquiries with regard to the cut of one shilling a week in the relief rates for widows and orphans in the City of Birmingham, and use his influence to see that nothing of the kind is done, because of its bad effect upon those concerned. These people have been cut down enough, surely, and it cannot be right that economy should be used in a way like that, to rob those poor people of the small pittance which is allowed them. I hope my right hon. Friend will go into this matter and give it his earnest consideration.

1.51 p.m.

Sir F. FREMANTLE: We have had a number of interesting speeches to-day and I wish to add to the general congratulations to my right hon. Friend the Minister of Health congratulations on his having had practically the encomiums of the official speaker for the Opposition, his predecessor in office, the right hon. Member for Wakefield (Mr. Greenwood), on the efficiency combined with economy which he has been able to report to the Committee to-day. Among the interesting speeches to-day, not the least interesting is the conversion of the right hon. Member for Wakefield with regard to economy. He has now definitely stated—and I think it is worth emphasising—that all would agree to economy with a view to efficiency in administration. That, is a very important point, and I think it is well to remind the Committee and him of the change which that means from the dicta to which he 'himself gave vent while, I think, he was Minister of Health, but certainly while he was on the Government Bench, when he said, on one occasion:
I will die in the last ditch rather than see any economy in the social services." And, on another occasion:
This country can afford anything it wants.
Those frank statements, made by him in those days, he has now repudiated or qualified, and it is very important to recognise that it is possible, in his view, to get economy and efficiency together. It is that that we and the Government have been aiming at all the way through, and have been denounced for aiming at, even by the right hon. Member for Wakefield in previous speeches. Therefore, we welcome his conversion to this point of view to-day.
I think the right hon. Gentleman was taken aback by the figures given as to the extraordinary position with regard to housing, for despite all the gloomy predictions made by himself and others as to what would be the effect of this economic housing policy adopted by my right hon. Friend, there has practically been no restriction in or halting of the schemes for building. The right hon. Member for Wakefield glossed over that position, as he might well do when he was unable to criticise it, but there are two particular points in regard to which it is our duty, from the back benches on this side, in support of the Government, to ask questions of my right hon. Friend, with a view to probing the actual state of affairs. We are all anxious still with regard to the position of housing, and the real criticism that has to be made, and that might well have been made from the other side, but has not been made to-day, is as to how far the new houses are really meeting the position which has to be met, namely, the position of the wage-earners, and especially the poorest paid among them. It would be easy for those who are merely critical to point to the fact that the houses that are going up are of such a kind for the most part that they can be let at an inclusive rent of 15s. a week, and whereas some of them can be let down to 12s. or even 10s. a week, and in agricultural areas, with the increased subsidy, at less still, at the same time the greater number do not provide for the needs of the people for whose proper housing the State is particularly concerned.
I want to meet that point, and I think it is necessary for the housing world to meet it. It is not enough to say that we are bringing down the cost and rent. The great mass of housing that is going on now is not of the low rental type which will provide the needs of the poorer-paid workers. The other day I was down in the south end of my constituency, a part which is only 12 miles from London. It was hitherto completely rural, and I was surprised to find that a builder from Yorkshire has bought up a large estate close by and is developing roads on a large scale with a view to building no less than 900 houses in the next few months. He is losing no time about it. These houses are springing up there, particularly because the London Tube is being extended
and will be within a few hundred yards of the estate. That kind of building is going on in the outskirts of London and the big cities and even of smaller provincial towns. Many people suggest that these houses provide for the needs only of those who are already sufficiently well housed and do not meet the real need. I am not going to argue that now.
I feel, and I think most people with a large view of housing feel, that the essential thing to do is to increase the number of houses of the general artisan type so that the houses they now occupy can filter down to provide a supply for the poorest class of people. It cannot he our eventual intention that the poorest class of people, who must always be with us, should be able to afford and be supplied with houses of the new kind. The proper economic arrangement is that they should remain in the older houses that are still habitable, but which, having come down in the world, naturally cannot command the same kind of prices; and that these houses should be relieved of occupation by persons of better means who can afford to have a house of the better type that is now being built. It is no criticism of the great success of the Government in their present scheme of housing that these houses should be of a higher rental than can be paid by the class they hope to relieve, because that relief will be only indirect. I think that, taking housing as a whole, the insistence upon slum clearance work is an admirable ideal and an admirable practical policy which has been neglected by previous Governments in their desire to increase their sum total of houses. If the right hon. Gentleman can fulfil the aim he has put before us and get a substantial way towards overcoming the slum problem within five years, and at the same time get a continuance of the building of houses of whatever class for the working-classes, then he is really tackling what requires to be tackled in the housing problem, 'and we shall be satisfied with the great economies that are being achieved at the same time by the stopping of the housing subsidy.
I want to mention a point that is commonly neglected. I think that it is neglected out of a rather natural desire not to stir up difficulties between employers and employed in the building trades, where co-operation is going on smoothly. We have every sympathy with
increased wages when they can be paid. We are, however, now trying to reduce the costs of building. Those who are responsible for building trade union affairs have achieved their object, which is a rightful object, of increasing the wages of those employed in the industry two or three times as much as those of most other trades. If they are calling, as they do, for the cost of houses to come down in the interests of those who are to be housed, it is time that they themselves made a contribution, and said, "We agree that there should be some reduction in the wage standards of the building trade which are so much above the standards of other trades." I think that it is only right that those who are keen on housing, namely, Members of the party opposite, should see if, by ordinary quiet influence and pressure on those in the building industry, there could be some contribution in this direction. There has been no such contribution at all, although there have had to be reductions in profits and in other ways in order to bring down costs.
The main point I want to emphasise in these Estimates is the possibility of further economy by way of co-operation or what has been described as co-ordination to prevent overlapping. My right hon. Friend the Member for Hastings (Lord E. Percy) raised the question of bringing town planning more especially into line with housing. I want to enforce that appeal. When the right hon. Gentleman the Member for Wakefield introduced his Slum Clearance Act in 1931, I was the first in Committee upstairs to raise the question why it had been brought in before the town planning Measure that he intended to introduce. There was no real reply, but we know what the actual reason was. It was that the right hon. Gentleman wanted to get through the slum clearance scheme, which had some electoral value, rather than the town and country planning Measure which had very little, if any, electoral value. He therefore left my right hon. Friend the less pleasant part of introducing the Town and Country Planning Act, for which he was violently opposed from his own party. The two Measures go together, and slum clearance ought riot to be introduced without a proper town plan.
I am afraid that local authorities have a very tepid and lukewarm view of plan-
ning. They are not really seized of the importance of planning, and I hope that my right hon. Friend's Department may insist more and more on having a proper town plan made now for that part of the town which is concerned in slum clearance before a slum clearance scheme is embarked upon. That is a correlative part of the campaign in which my right hon. Friend is now engaged. If we co-operate in that way, the appeal of my hon. Friend the Member for East Carliff (Mr. T. Morris) with regard to the planning of sites for factories is of great importance. Most of those who know a good deal about planning recognise that we must not go too far in planning the future for industry or sections of public activity that are bound to be the subject of private initiative and development. We should stifle the development of industry if we were to lay down that factories can only be developed here and there. All you can do is to guide, but a great deal can be done in the way of guidance, and I hope that further attention will be given to the necessity of planning factory development and housing development.
The right hon. Gentleman did not mention it, but I am sure it would be useful if the Parliamentary Secretary, in his reply, could say something on the prospects of our receiving a report from the Committee, which was re-appointed by himself, inquiring into the future development of existing towns or the development of new towns in the form of garden cities from the point of view of residential and factory planning. Lord Marley is Chairman. It has been sitting off and on for a couple of years, and 1 hope that its report will be out very soon and will lead to some useful results. The value of co-operation between the different functions of the Ministry has been very well illustrated by several of the speeches, and not least by that of the hon. Member for Gorbals (Mr. Buchanan). It is obviously anomalous and a mistake if pensioners, having exhausted certain rights under National Health Insurance, have to leave a panel doctor and go to a, Poor Law doctor. Why should we have that distinction between the system of the panel and the system of the Poor Law when both are administered by the same Department? Is it not possible to fuse the schemes for the provision of medical benefit, whether
they are under an insurance scheme or a public assistance scheme? As things are' there is a stigma, dating from old times, to everything connected with public assistance, because it has inherited Poor Law traditions and Poor Law machinery, and that we want to break that down.
I am speaking from the professional point of view. It would be infinitely better, as the hon. Member for Gorbals said, if we could have a panel or other system—however inadequate the panel system must often be, by reason of the nature of the service—under which one medical man would be able to look after the interests of all the members of one family, and then decide in what way he should be paid, whether from the Insurance fund or some other fund.
Further, I would like to ask whether there are any signs of the co-operation we were promised under the Local Government Act of 1929 between the voluntary hospitals and the hospitals under local authorities. In London we get the problem in its biggest sphere, and it is a difficult problem to deal with in London, though one would imagine under the conditions here they would be foremost in devising some scheme of co-operation. It has been under the consideration of the voluntary hospitals, the larger voluntary hospitals especially, and of the London County Council, and yet rumours come to me from time to time that their cooperation is little more than nominal. Elsewhere in the country things are working well in some places, especially where the membership of the local authorities is largely the same as that of the agencies running the voluntary hospitals, but in other places the two classes of hospitals are definitely opposed to each other, and grate upon each other, and are doing nothing to try to co-ordinate their services. This should be a matter of constant care on the part of the Ministry of Health and I hope pressure will be brought to bear upon those places where co-operation has not been brought about in order to make it effective.
The point came before me this week in a small way, but one that will serve as an illustration. While visiting, on behalf of King Edward's Hospital Fund, one of the smaller hospitals in an outlying area of London I found a scheme under which two of the hospital's nurses were actually
engaged in the work of district nursing for the whole district. They deal with the outpatients in the hospital and follow up the cases and also do the ordinary work of district nurses. They are working under the same doctors, with the same sets of people, and get to know them. No longer is the work done by two agencies, the hospitals on the one side and the district nursing association on the other; the work of looking after the people is done by one and the same agency. with a great deal of saving. I hope the right hon. Gentleman and his Department will see how far this idea can be pressed forward. The voluntary hospitals on the one hand and the district nursing movement on the other hand, especially under the Queen's Institute of District Nursing, are doing a great work all over the country, with immense credit to all those concerned, but they are separate bodies, with separate schemes for raising contributions which clash in the different areas, and I think the time has come for co-ordination. At St. Albans, after three years of negotiation, an arrangement has been come to between the hospital and the district nursing association to work in together and co-operate in the matter of contributions for nurses pensions.
There is a very great grievance in the nursing profession regarding nurses' pensions. A nurse who moves in order to improve her position may go from the service of a voluntary hospital to a hospital under a local authority, or vice versa. In moving in this way from one to the other she loses her pension rights. We ought to get co-ordination between the pensions schemes of local authorities and the pensions schemes of voluntary hospitals. It will be difficult to arrange it, but I believe the subject is to be brought forward by those who represent the nursing profession, and I hope the Minister of Health will turn a kindly ear to their proposals and give them help, so that we may have one scheme in the interests of the splendid profession of nursing which has done so much magnificent work and on which we must depend so largely in the development of the health services of the country.
There is one further suggestion for the co-ordination and fusing of the health services. The opportunity comes under the Local Government Act, 1929, and with the new arrangement of public assistance committees. Why should we
be tied down to the present watertight compartment system, with the same local authority having different sets of officials to manage different branches of the health services? The education clinic service is very often a watertight compartment, the hospital services a watertight compartment, the tuberculosis services largely watertight also, each under a different committee and with practically independent officers and an independent organisation. The whole subjects wants overhauling, and I think the time will come before long when the Minister will have to appoint a further committee to make an inquiry, not only with a view to economy, but also with a view to a closer fusion of services which are now more or less under the same local authorities. I think probably a very special investigation is required before any definite steps can be taken. It goes right back to what are the real requirements in the training and education of the medical services.
I am afraid that that is outside this Vote, and that it is outside the power of the Minister to decide what is to be the future of the training, but I think the Minister has a responsibility for urging upon the General Medical Council, through his own representative on that Council, the fact that in training attention is still directed too much to the production of practitioners for the treatment of disease, and not nearly enough to the training of medical men in the prevention of disease rather than the cure. The prevention of disease is still considered quite a subsidiary and minor part of the training of the medical man, and we in Parliament, from the national point of view, want that training to take a larger place. It is grossly overlooking the real needs of the health of the nation to allow the idea to continue that clinical medicine and surgery should have nine-tenths of the training of a medical man and prevention only one-tenth.
There is a further point to be borne in mind which the Minister himself must take his part in promoting. More and more we are learning, especially outside the medical profession, the enormous value of actively promoting health by physical education, and a very large number of suggestions are brought forward by quack practitioners, as they are called, but which are warmly espoused
from different points of view, for improving and increasing the natural health tendencies of the body so as to enable people to continue a healthy life 10, 20 and 30 years beyond what they would otherwise do. I think that the Minister has to pay attention to the physiological as well as the pathological views on life. At present it is a side-line, an anomaly in the health service which can hardly dare be mentioned. Every now and again the point crops up in connection with X-Rays, electrical treatment and so forth. It is simply brought in as an extra, and yet there are officers of the Ministry and other medical officers who give their services to this kind of work. It is outside the ordinary ambit of medical views and ideas, but this physiological development of the health of the people is enormously valuable in connection with the unemployed, especially in distressed areas.
We see it brought to a high art in. countries like Italy and Germany, where they take fresh views at the present time, and we can always learn lessons from other countries, especially when they take very different lines from ourselves. I do want the Ministry of Health to give more consideration to the development of the positive side of health promotion, and the periodical examination of the whole people, by those who can give useful advice to retain health-a system that might be brought in touch with our insurance schemes, in order that, if they be recognised, a, very large proportion of the ailments with which the Ministry of Health is battling so splendidly at the present time may be prevented.

2.21 p.m.

Colonel CHAPMAN: May I also congratulate the Minister upon the manner in which he is tackling this great problem of slums? We know that he has firsthand knowledge. I remember he went to Tyneside last year and went thoroughly into the slum houses, and how much struck he was with the horror of the conditions. He has stressed the urgent need of economy and explained what is being done with regard to economy in his Department. In case some municipalities may take his call for economy as a reason for not getting rid of the slums, may I mention that in South Shields, where one of these schemes was recently completed, instead of costing the town £3 15s. a house, owing to the increased rateable
values of these houses compared with the hovels from which the people were removed, it actually is costing the rates only £1 15s. a year per house. I hope the Parliamentary Secretary when he replies will give us some information with regard to his inquiries into suggestions put forward a little while ago at Stockton about the removal of people from slums into new housing estates. My observation is that if people are removed from slums to these new houses, it will be beneficial in every way.
I cannot, I am afraid, congratulate the Minister to the same extent as far as his negotiations with the building societies are concerned in connection with the Housing (Financial Provisions) Act. He was persuaded by the building societies that it was not any part of the ordinary business of the building societies to advance money on properties to let. With that I am in entire disagreement. Most building societies since coming into existence have done that as part of their ordinary business; and, secondly, that the demand of owner-occupiers was drying up. May I respectfully submit that the demand has scarcely started by artisans, because the house they could afford to buy has never yet been on the market. It is only now that houses can be built at a cost of from £350 to £400, and I am hoping that the demand will be so great that the Minister before long will recognise that he would have been doing much greater service to the working classes of this country if he had persuaded the building societies to advance money to small owner-occupiers of newly-built houses of a less value than £400 at 4 per cent., than to persuade them to advance money at 4 per cent. to people to build houses to let. May I remind the Committee what the Lord President of the Council said quite recently at the annual meeting of the Abbey Road Building Society. He said:
The housing shortage has had this salutary and valuable side, that it has been the prime inducing cause in setting up first the necessity and then—shall I say?—a custom of home ownership. … The word 'home' is a word of infinite potency for our people, and in striving for one's own home one experiences a double stimulus, a stimulus to one's self-respect and one's independence, two virtues that I love to think are still characteristic of our people and will always be, whatever part this or any other Government may play in the lives of the people—
a stimulus to self-respect and to independence.
I respectfully suggest to the Committee that if we could by some means enable men in their working days to buy their own houses, so that when they have to go to their old age pension, in due course, they could live in those houses from which the debt had been discharged and, with a small garden and a pension of 20s. for their wives and themselves, they could still be useful members of the community, absolutely independent of their relations or of the State to keep them.
Let me give an instance of what has been done in Tyneside with regard to the building of small houses. Some months ago, I referred to the activities of a builder in Newcastle-on-Tyne who was erecting small houses at a cost of about £350. In less than three months, the same builder has started a similar scheme. He started on 1st April to build 136 houses. He has completed two of them, and others are in various stages of completion. He has actually sold 19 houses, and there is still a great demand. The houses are being sold at £399, freehold, and with roads, sewers, law costs, stamps and everything paid for. Arrangements have been made for buyers to deposit £25, and to get the remainder of the money on mortgage. If they could get the money at four per cent. through the building societies-which could be done I am sure by means of the persuasive powers of the Minister-instead of at five per cent., the buyers would be saved more than £100.
What does the present scheme amount to? Houses are being built with the assistance of cheap money by the building societies and, as the Parliamentary Secretary has said, a house costing £360 can be let at 10s. per week plus rates, or 12s. 6d. in all. Does not this mean that in 30 years the tenant is buying the house for the owner and, at the end of that time, the owner still keeps the property and the tenant goes on paying the rent of 12s. 6d.? Such a rent is not what we in the north must look forward to, because we want houses which can he let at an all-in cost of from 7s. 6d. to 8s. 6d. I believe that that can be done, if the Minister will direct his attention to it. The Minister is rather too complacent about the reduction of unemployment in the building trade in five months by 131,000. That is tremendous, but we
want to look at the unemployment still in the trade. There are still 175,000 men out of work in the building trade, or 20 per cent. of the total employees in that trade. In the north-east area, there are 22.5 per cent. That is the one industry in which the Government can really help to get some unemployed back to work. In Tyneside, 70 per cent. of our ship-repairers are out of work, 40 per cent. of our miners, and more than 50 per cent. of those engaged in running the ships.
In 1927 there was the least unemployment in the building industry. In May, 1927, there were only 6.6 per cent. out of work, and during the year, only 10 per cent. Last year, the average was 28 per cent. What has been the result? Having those men in work in 1927 meant that 273,000 houses were built, whereas, in the last year or two, we have never exceeded 200,000. It shows that there are enough people in the trade to enable us to build between 270,000 and 300,000 houses a year. I believe that if there were a real effort at State building, we could get back to the number of 275,000 that we built in 1927. The Minister seems to have set his heart entirely against subsidies in any form or kind, except in regard to slum clearance, but I believe that if we could provide an impetus to building we could reach that figure. I am told that there are enough unemployed operatives in the building trade to build 100,000 houses, but that, so far as bricklayers, plasterers and slaters are concerned, this number might have to be reduced, and that there are only enough to build an additional 85,000 houses. Let us put the number at 70,000.
Will the Committee bear with me for a minute or two while I give a few figures? Let the Government raise a housing loan at 3½ per cent., to the extent of £75,000,000. I believe that this great country, if the matter were put to it in a way that would show what could be achieved, and if that money was available, might lend it at three per cent. Having raised the money, let the Government arrange to spend £25,000,000 in each of the next three years, in providing small houses to cost under £400 each, and let those houses be built by the municipalities or by housing trusts. The Government would lend the money at three per cent., bearing the other half
per cent. themselves while there would be a sinking fund charge at half per cent. That would be one per cent. on £75,000,000, or £750,000 a year, which the Government would ultimately have to find for 60 years. I am going to persuade the House that that could be done, at this stage, without costing anything. The 225,000,000 per year would build 71,000 houses at about £350 each, and if interest were charged annually to the municipalities, or to the housing trusts, at three per cent., that would be 10 guineas per year or 4s. per week in rent. If that is added to the rates, repairs and maintenance, which we will put at 4s., you have a house at 8s. per week rent, which is just about what the north country people are likely, during the next decade, to be able to afford. They cannot look forward to an average wage in any trade higher than £2 10s.
How is it that this is not going to cost the Government anything? The £25,000,000 spent on housing would provide in wages about £20,000,000 a year, which would give work for 133,000 people at £3 per week. Those 133,000 men are at present drawing the dole averaging £1 per week; in respect of each of those men, the Ministry of Labour would be saving £50 a year, which would amount to a total of £6,000,000 or £7,000,000 each year. In the three years, that would amount approximately to 219,000,000. The present value of £750,000, which is the total annual cost to the Government for 60 years, is about £18,000,000, so that in that way, I suggest, the Government would not be losing by this transaction. Of course, if, in addition, £25,000,000 were being spent in the building trade, all the other trades in which that money was being circulated, would benefit. There would be other small savings, resulting from 133,000 more men being in work instead of drawing the dole, because they and their employers would be paying into the Insurance Fund £4 per year each, which would represent about £3,000,000 per year. Then, of course, if this building were going on, builders could not be doing it without making some profit, and some of that profit would go back to the Chancellor of the Exchequer in Income Tax. I suggest that this is a real scheme, to which the Minister should give his attention. We must find a way by which men engaged in industry can rent houses at
much lower rents than seem to satisfy the Ministry at present. In the three years we should have built 210,000 additional houses, and should have given employment to 133,000 additional men.

2.36 p.m.

Dr. O'DONOVAN: I thought that the Debate was at last beginning to turn on right lines when the hon. Member for St. Albans (Sir F. Fremantle) was called upon. Although it is true that the Estimates of the Minister's Department cover a very wide squirearchial range, including the care of widows, aged, housing and insurance, nevertheless his title is that of Minister of Health, and it would perhaps have pleased the sick and the doctors if more had been said on this aspect of his functions. The Minister of Health has presented his report of the year's work of his Department in a modest and persuasive fashion, and I cannot think that the opposition will attempt to rob him of £100 in consequence of that report. But behind the Minister is his Chief Medical Officer. We in the House of Commons have thanked great generals who have been ministers, not of life, but of death, and it would be only fitting that a practising physician should say how much the whole practising medical profession appreciates the selfless devotion to duty, spread over many years, of Sir George Newman, the Chief Medical Officer of the Ministry of Health.
We have had references to regional medical officers, and one slight reference to panel doctors, but the whole of the work of the Ministry must fall and crash unless there is, generation after generation, a supply of good medical students; and, as a teacher of students, I assure the Committee and the Minister that the students who are coming along in this year of grace are as good a vintage 'as we have ever had in the profession. I should have been pleased, had time permitted, if the Minister had referred to the work of the voluntary teaching hospitals, for the stream of health endeavour cannot rise higher than its source, and our teaching hospitals and medical schools are the places from which we send out young men anxious to conserve and preserve the health of the people; and, if these teaching centres receive the Minister's favour, all will be well in the villages and in the hospitals of the country.
I must join issue with my hon. Friend the Member for St. Albans in regard to his reproachful and special outlook that we practising doctors are not concerned with preventive medicine. The Minister would not be where he is but for years of persuasion and agitation on the part of the clinical profession. My ancestors in medicine saw the need for preventive medicine, but they had first to force upon the people and the Government the idea that the care of the people's health could be organised, and, if we now have a Minister of Health, it is thanks to the innate preventive instinct of the clinical profession. When a student is taught how to extract a tooth, it is not a simple mechanical act that he is learning; he is preventing a whole stream of septic complications that ends in the churchyard. We do not remove an appendix for the pleasure of removing a worm-like organ, but for the purpose of preventing the patient from dying of general peritonitis. We administer chloroform in order to prevent pain, and not for the pleasure of laying out a man unconscious. The whole practice of medicine is soaked in prevention, and it would be very wrong if anyone went away from the House with the impression that the practice of bedside medicine is anything but the practice of preventive medicine. I am certain that when the two branches realise that we have but one aim and one object, the squabbles which have occasionally and necessarily broken out, and which are a sign of light as well as of heat, will end in fraternal amity.
The Minister has referred to the formation of a committee for the standardisation of hospital building. This may be good, and I hope it will he, but it affords me the opportunity of drawing attention to a popular idea that the building of hospital beds is the maintenance of health. A big hospital with many beds is, unfortunately, a hall-mark of our failure to conserve health. What we need is not more beds, but more brains applied to the preservation of the people's health; and the development of outpatients' departments staffed by the very best physicians is more worthy of the Minister's care than the opening week after week of great monuments to the failure of our efforts.
The other Committee to which the Minister referred leaves me with a strange
feeling-a committee to investigate the sterilisation of the unfit. We, of course, as scientific men, must welcome all attempts to collect knowledge, but when you have collected the facts about the procreative rate of the village idiot, and its effects upon the British Empire, you have not touched the fundamental question as to whether, with those facts before us, it is ethically right or wrong to mutilate, with or without his consent, another human being. As the Minister very properly said, when these facts have been obtained, the decision as to action will rest in the House of Commons. The House of Commons opens its proceedings with prayer, and at least the Lords Spiritual will remind us from another place if we forget our lessons learnt at our mother's knee.
One has to remember that this inquiry as to the sterilisation of the unfit is perhaps a sop, and only a sop, to a modern tendency to accept with pleasure the diminution of population and even tolerate the official organisation of abortion and other strange ideas which are spoken of by the Chief Medical Officer of the Ministry of Health as pagan ideas. We welcome any inquiry, but one hopes that before any action is taken the argumentation in the House of Commons will be close and thorough.
Reference has been made to action with regard to maternal mortality. I hope that the first action will be more and more research. It is lamentable to say so, but we do not know why the tides of maternal mortality are slowly rising against us, and, therefore, any action which crystallises present practice may be action in the wrong direction. One would therefore ask the Minister to foster at present, not active work, but active research, and to let interference wait on the result of proved researches. Another point to which I desire to refer is the question of the efficiency of infant welfare centres and other clinics. They are arising in abundance around us, but I should say that they are only 90 per cent. efficient. They act as great nets for sorting out the sick and the fit, but when difficult cases arise, they are sent at once to the voluntary hospitals for diagnosis and treatment. That is to say, the consultants of London and the other great Metropolitan centres are really adding that touch of efficiency which makes these centres worth while. The Minister said
that the abolition of tubercle and certain other diseases was due to the great work of these infant welfare centres, but I would extend my thanks to those who see that the people have clean food and clean houses, and that the herds of cows are less tuberculous than they were. There is a whole army of public work going on on the preventive side of medicine, and I do not think that the infant welfare centres themselves should claim that the great drop in child mortality is entirely due to their work.
This afternoon's Debate is to me one of extraordinary interest, because to-day, in a way, we have had under inspection as Exhibit A the Minister of Health; and we know that, when we go to the street corners and the market places at the next election, the public will be more interested in what has been done by this Minister than in what has been done by almost any other Minister of His Majesty's Government. None of us here can quite control what he does, for his work is done through the borough councils, and so on, and, if that work is badly administered, the National Government must suffer. One hopes that the same amiability and the same spirit of benevolence that the Minister and his chief officials always show will be found in the county councils and their medical officers. If democratic government is to survive, there must be some means by which proposals which affect the health of the people and the working of the whole medical profession should be discussed by the organised profession. It is the custom of the Minister to send his officials to all organised meetings of the medical profession, and I hope he will find it possible to give directions that medical officers of health will have the same facilities for going freely to professional meetings to discuss matters that affect the public health with the clinicians, who are as closely concerned as His Majesty's Ministers with the well-being of His Majesty's subjects.

2.46 p.m.

Wing-Commander JAMES: I shall not detain the Committee for more than two or three minutes. May I first congratulate the Minister on the appointment of the Departmental Committee to investigate the question of sterilisation. This subject may be said to be sub judice for the moment so I will only say how
pleased many people are that he has appointed the committee. I should like to know what steps the Department takes in the ordinary routine course of its duties, in collecting information in the matter of heredity. There is a growing volume of opinion, not only among medical men in general, but particularly among medical officers of health, as witness a recent article in their Journal, that, if we are to make real progress in the health of the people, we have to go right back to heredity. These are the directions in which I might suggest that research is needed if it is not already being made! Firstly, in the case of discharged mental defectives, what information does the Ministry collect as to the subsequent procreation of these people, and what are the children like? Then with regard to children in the special schools, I have been told by a reliable informant that, when they go out into the world, they tend to marry at an earlier age than normal children land tend to have a number of children. Is that the case? That is the sort of question that might be kept under the permanent review of the Department. Then there are certain categories of blindness which, I understand, are about 100 per cent. hereditary. Is a watch kept upon blind persons. Then there are the deaf and dumb. Every now and then one reads in the Press of a romantic marriage between two deaf end dumb people at the same institution. No one would wish to deprive these unfortunate people of any comfort or pleasure they can possibly obtain, but what is the aftermath of such unions?
There is the question of the proportion of the unemployed who, owing to their deficiencies, whether hereditary or environmental, again no fault of their own, are unemployable and who must of necessity tend to depress the wage standard in unskilled trades. The public conscience on these subjects is being roused, it might be wrongly, but the collection of scientific information must precede any action such as is now being demanded by is large section of the population. I am not suggesting that there should be any extra staff or extra expense. I would point out one recent instance in which, without any increase in the cost of administration, some striking information has been collected by the Society for the Preven-
tion of Cruelty to Children. In their 49th Annual Report, in response to the public demand for investigation of these problems, they instructed their inspectors to investigate the relationship of mental deficiency and cruelty to children. May I quote a few concluding lines of the report, as given in the "Times" of May 2nd last:
Another matter that is causing the Society some concern is the number of cases in which mental deficiency is a serious factor. For the first time figures as to the proportion of mental deficiency amongst parents whose conduct has been complained of have been compiled. The number of living children under the age of 16 in the cases dealt with, where one or other parent was feeble-minded, with 9,813. This gives an average of between four or five children to each family.
Whether that feeble-mindedness was hereditary or not, can anyone maintain that a feeble-minded person is a desirable person to bring up a child? They may be, they very often are, the kindest people in the world, but one questions their competence to bring up children. I am aware that there is a large volume of opinion which has very deep religious convictions on the subject, but that body of opinion cannot possibly object to what I am asking for, which is regular, scientific inquiry into the facts of the case. The hon. Member for Mile End, Stepney (Dr. O'Donovan) appeared to be throwing cold water on the Committee of inquiry, and I thought he was possibly rather weakening the position that he takes up. He should welcome inquiry. This information is badly needed if at some future time this swelling stream of human misery is to be stemmed.

Dr. O'DONOVAN: Perhaps the hon. and gallant Gentleman will concede me one point, that one may differ from his line of thought and its development into action on scientific as well as religious grounds. Perhaps he will not insist on confining me in a pen of his own manufacture.

3.54 p.m.

Mr. DICKIE: I intervene because of something that was said by the Parliamentary Secretary on the distressed areas Vote last night. He pleaded, almost with tears in his voice, for some sign of gratitude for the work of his Department. I want to ask him not to include me in his category of thankless
children. The Minister today has referred to the very serious question of housing and overcrowding. I represent a constituency in which we have had, and still have, a very serious shortage of housing accommodation for the working classes. Owing to a variety of causes, we have had great difficulty in overcoming that shortage. The Government introduced a comprehensive Bill for dealing with the whole problem, one of the features of which was the withdrawal of the subsidy.
The Committee will remember that the Minister gave a pledge that where local authorities could show that their schemes had either been submitted or were ready for submission before a certain date, a most generous consideration would be given to those authorities in deciding whether they should or should not be allowed to construct the houses with the subsidy. Speaking from my own knowledge and experience, I can say that that pledge has been nobly redeemed. I have experienced several cases of the kind, in every one of which there has been nothing but fairness, kindness and consideration extended by the Minister, the Parliamentary Secretary, and from the capable and careful officials of the Department, and I am extremely grateful. The Parliamentary Secretary, in his little homily on the virtue of gratitude, rather invited a reply, and I respond both with alacrity and with pleasure, and I hope that this little tribute to the work of his Department will convince him that, while we may sometimes be critical, we are never ungrateful.

2.57 p.m.

Mr. RHYS DAVIES: I rise at this moment in order that the Parliamentary Secretary may have ample time in which to reply to the very interesting Debate to which we have all listened. I join with other Members of the Committee in saying that it has indeed been a very enlightening discussion. I want to touch upon some comments made by hon. Members upon the statement of the Minister. I am very pleased to see the noble Lord the Member for Hastings (Lord E. Percy) in his place because he made a most astounding statement in his short speech. He said that we have a right to expect an increase in mortality rates. That was an astonishing thing to say. If this nation were too poor
as a whole to provide the necessities of life for the people I should probably agree with the noble Lord.

Lord E. PERCY: May I explain that when the birth-rate falls and the death-rates falls you have an increasing number of people over the age of 50 and 60 in comparison with the rest of the population and therefore mortality rates rise because of the greater average age of the population and unless you are to abolish death that is bound to happen.

Mr. DAVIES: The noble Lord will remember the old adage that figures can lie. I will ask him a very pimple question. Is it not a fact that all statisticians measure our progress towards a higher civilisation by the infant mortality rate based upon a given number of deaths out of every thousand births during the first year of life? That is the formula. I challenge the noble Lord by telling him that there is no reason at all in this country for a statement such as he has made this morning that we have a right to expect an increase in the mortality rates. What he has just told the Committee has not the slightest relationship to the infant mortality rates which the most important of all.

Lord E. PERCY: Of course it has not any relation at all. What the right hon. Gentleman the Member for Wakefield (Mr. Greenwood) and I were talking about were the mortality rates and not the infantile rates.

Mr. DAVIES: The general mortality rates will include the infantile rates because the children die.

Lord E. PERCY: And included in mortality rates which are bound to go up.

Mr. DAVIES: The noble Lord will not be convinced by anything I say and I am not convinced by anything he says so the feeling is reciprocal. The hon. Member for Dundee (Mr. Dingle Foot) complained very bitterly about the position of about 100,000 insured persons under the National Health Insurance Scheme who will lose their medical benefit at December 31st, 1933, because they are unemployed. I was delighted to hear him add a word to the effect that he took the responsibility of his own actions in the matter. When the amending Bill of the National Health Insurance Scheme
was before the House in 1932, we pointed out from these Benches all that is happening now. Hon. Gentlemen on the opposite side of the House who are now complaining were told exactly what would happen, and consequently they must take the consequences of their Vote on that occasion. Hon. Gentlemen opposite ought to cross the floor of the House and Vote against the Government on everything and then they would be safe.
Another statement which astonished me was that made by the hon. Member for East Cardiff (Mr. T. Morris) when he said that there were no slums in Cardiff. I do not know whether he meant to give an invitation to us all to go to that City for a holiday. It would seem that Cardiff is indeed a very delightful place in which to live. But you cannot judge Cardiff only by its fine public buildings. I should like the Paliamentary Secretary to give, in reply to the hon. Member for East Cardiff, the correct definition of a slum. I live in Manchester where there is supposed to he a great deal of slumdom, in Ancoats and Hulme. I know Cardiff very well and if the slums in Manchester are properly defined I am certain there are slums in Cardiff too. It seems to me that the Tory will find that differs from our outlook on slumdom.
As to the little scuffle, metaphorically speaking, between two members of the medical profession, the hon. Member for Mile End (Dr. O'Donovan) and the hon. and gallant Member for St. Albans (Sir F. Fremantle), it is very interesting for a layman to hear these little differences of opinion between members of the medical profession. We are not unaccustomed to them in connection with workmen's compensation cases. When the hon. and gallant Member for St. Albans says that we on these Benches, in order to reduce the cost of building houses, ought to appeal to building operatives to agree to a reduction of their wages, I should like to ask him a question. If we were willing to consider his proposal, would he be willing in return to consider a proposal for the reduction of the salaries of the medical profession? That is a fair question. I remember that when the Government appealed to the medical profession to reduce the panel fees some time ago from 9s. 6d. to 8s. 6d. there was a terrible commotion among the medical profession.
I remember also how very powerful the doctors were in their organisation when the Insurance Act came into operation in 1912 and how they fought strenuously for their rights in that connection. The hon. and gallant Gentleman attacked the Member for Wakefield (Mr. Greenwood) and said that my right hon. Friend had changed his mind and that he now believed in economy. My right hon. Friend is able to take care of himself, and I will leave the matter at that.
I wish to put two or three specific questions to the Parliamentary Secretary. He will probably know—and the point has been raised already in the House—that the medical officer of health for Stockton-on-Tees has made a report which has astonished a large number of people, and especially students of vital statistics. This is his argument—and the point really ought to be cleared up—that in removing families from slumdom in Stockton into a new housing estate the poor people so removed had not the wherewithal because of the higher rents of the new houses to buy the necessary food supplies in order to keep them physically strong, and consequently the infant mortality instead of declining as the result of the removal to new property had actually increased. That is to say, that the infant mortality rate instead of declining by the removal of the people to new houses actually increased. I have made inquiries, and the experience of Manchester belies everything that has happened in Stockton. It has generally been understood that when you took people from slumdom into new property the infant mortality declined automatically. There must be an explanation in regard to Stockton-on-Tees, and it may be a good one. The Minister ought to tell us what the explanation is.
When the hon. Member for St. Albans was criticising the right hon. Member for Wakefield about economy, I was reminded of the fact that there is a committee sitting at the Board of Education at present, and there is an impression abroad that it is trying to find out how much could be saved on the present school medical services. It is very important to remember that that Committee has been appointed by the present Government and that while we have the Minister of Health to-day moving his Estimates and speaking is if every-
thing was beautiful in the garden, we have a committee sitting, behind the scenes as it were, inquiring if some saving can be made on the school medical services. We are entitled to know what that committee is actually doing and what are its terms of reference.
I come to another point mentioned by the Noble Lord the Member for Hastings. Every one who takes an interest in our health services will measure our progress very largely by that fundamental test of statistics—is the infant mortality rate increasing or decreasing? As a layman I very early learned that lesson, especially when I was a member of the Manchester City Council. When the reports of the medical officer came before us we always tested the health of our city on that simple point as to whether the infant mortality rate had increased or decreased.
The statement of the Minister to-day was very interesting, except that, as I have said, it seemed to point to everything as being beautiful in the garden. Let us put his statements to the test. He did not give us the infant mortality rates for England and Wales up-to-date. We are under the disadvantage to-day that we have not at hand the report of the Ministry of Health for 1932. We have, however, the Fourth Annual Report of the Department of Health for Scotland for that year. In that respect the Scottish people are much in advance of ourselves. In the Report of the Department of Health for Scotland for 1932 there is recorded an increase of 4 per thousand in the infantile mortality rate over 1931. That is a very serious increase for the community to face. The slightest increase in the infantile mortality rate is a very serious thing for a nation. For the last 50 years the figures have declined, and therefore an increase of our infantile mortality even by one per thousand is very ominous.

Wing-Commander JAMES: May I point out that inevitably there must come a time when the infant mortality rate must rise, for the simple reason that ever since it has been going down it has meant that an increasing proportion of the less healthy lives have reached maturity, and when the time comes for the less healthy children of those people to become reproductive, automatically a less healthy stock must be produced.

Mr. DAVIES: That is an argument and not a fact and I decline to accept it. I have as much right to my point of view as the hon. and gallant Member, and I would not be surprised, comparing my public experience with his, that I have a greater right to believe in my point of view than he has to believe in his. Suppose we admit the argument of the hon. and gallant Member—I am not arguing as to whether the figures are justifiable—was the Minister of Health right to-day in giving us the idea that infantile mortality rates are not increasing in England and Wales when in fact, the report for Scotland shows an increase of four per thousand.?

Wing-Commander JAMES: Will the hon. Member allow me to interrupt him once more? He and his party are constantly pointing out, quite rightly, that we are living in a scientific age, yet when a humble individual member produces the most elementary piece of biology he says it means nothing.

Mr. DAVIES: I am not sufficiently conversant with biology to argue with the hon. and gallant Member, but I know from my experience, and I think he will agree with me, that the mortality rates of this country have improved because of four or five definite factors. First, a good water supply; secondly, improved sanitation; thirdly, an improved medical service, and, in the fourth place, better housing and the development of our social services. These factors together have accounted in the main for the improvement in our mortality rates. The point of the hon. and gallant Member does not in my view avail him very much, but if it will please him I will study biology during the week-end. I want the Parliamentary Secretary to say a word or two about the water supplies in this country. It is a matter of common knowledge that in a large part of the country the water supply is not good. Some years ago some of our largest municipalities made arrangements for increasing the water supply in the belief that the population would increase and that our success in the markets of the world would continue. I want the Parliamentary Secretary to tell us the policy of the Government towards the regional committees which are set up for the purpose of keeping the water supply up to date, especially in rural areas.
The Minister of Health did not say one word to-day about the flooding in the Don Valley area and other parts of the country.
I come to something about which I profess to know a little—and it has nothing to do with biology. I refer to the complaints that have been made about national health insurance and to the human tragedies which arise from the passing of the Act of 1932. I must ask the Committee to go further back than the Act of 1932. The trouble about national health insurance started when the right hon. Member for Epping (Mr. Churchill) reduced the annual State subsidy to the scheme by £2,750,000. So long as Parliament decides that the scheme shall continue to be based upon insurance and actuarial principles either the whole or part of that money must be brought back into the scheme, otherwise it will struggle along for many years on an unsound financial basis. Let me come down to what the Department is doing about National Health Insurance. I have been amazed at the difference in the attitude of the public towards this scheme and towards Unemployment Insurance. There are more people covered by this scheme than by Unemployment Insurance; there are 17,000,000 insured persons under this scheme.
The Parliamentary Secretary knows that the scheme suffered a terrible blow when, in 1926, £2,750,000 was taken from it yearly, or £30,000,000 up to date. What is the Department doing now? I congratulate the Department on having some very clever men who can think of doing the sort of thing I am going to mention. When the next valuation comes along it will not, of course, produce as good results as the previous valuations, and in order to make things appear better than they would otherwise be the Department has decided that the approved societies, in order to swell their assets for the purpose of that valuation, must at once bring into those assets all their property, which has hitherto been wiped out of revenue account, as would be the case in any ordinary business. It is a very clever proposal. I ask the Parliamentary Secretary whether he has any idea how much those assets will be when brought in. Presumably it will include all the buildings, office stools, the inkpots and pens belonging to the approved societies.
They will all be brought in for the next valuation in order to make it appear that the National Government is not as bad as it really is. That is the intention.
Then the Department is doing something else: It is very interesting to notice what government departments can do without telling anyone. An approved society gets 4s. 6d. per member per annum for administrative purposes, and, of course, most societies have little balances on this account. The Department has decided, in order once again to bring all possible assets into the next valuation, to compel societies to transfer their balances on administrative account, every penny above one shilling per member in the society. It is all very clever, but I think Parliament ought to have been told beforehand that it was to be done.
Let me reinforce the point that was made by the hon. Member for Gorbals (Mr. Buchanan) and others as to some insured persons falling out of the Health Insurance Scheme and losing their title to pensions and medical benefit. I understand that at the end of this year all persons 58½ years and over who are genuinely unemployed whilst retaining their pension rights will lose their medical benefits. It is estimated that there are about 100,000 such persons. I ask the Minister whether it is not possible by administrative action to save the medical benefit of these men. Of course the Government have already taken some steps to do that. But let us see how. They know that they made a mistake when they passed the Act of 1032. They have seen their mistake since, but of course a Tory never wakes up until it is too late. That is a Tory habit. See what the Government have done. In order to get over the mistake made in 1932 the Government has now told the approved societies, "If you have surpluses in your hands we will allow you to use them to pay the arrears of unemployed members and so keep them in benefit." But see the result. The society of which I am secretary is the best in the country and has a surplus and is able to do all that. Of course, it is well managed.

Mr. BUCHANAN: But you have very little unemployment.

Mr. DAVIES: There is some unemployment.

Mr. BUCHANAN: Not proportionately to the others.

Mr. DAVIES: Apart from that point, which we need not argue now, the problem arises that some societies are better placed than others. My society does not include miners. We have no engineers, and no textile operatives, and our people, in the main, are employed and consequently we are better off though we have some unemployed. But I ask the Committee to note the unfairness which arises in this connection. You may have a group of men in one of the well-to-do societies and their pensions will be safeguarded simply because they are in that society, whereas there may be another group in another society who have paid exactly the same contributions for exactly the same period but who will fall out of the scheme altogether for pension purposes. Now that the Ministry have found out the mistake made in 1932 and have come to the aid of these men, partially at any rate, through the best of the approved societies, why cannot they adopt the recommendation of the Royal Commission on National Health Insurance which made it clear that it was the duty of the Ministry to undertake the partial pooling of surpluses to meet the cases of these unemployed people? That is what I am going to ask them to do and it is not too late yet to do it. They can take it from me that, though this issue may appear small to the Ministry, it is a very serious thing in the country. Let me put it to the hon. Gentleman who is apparently smiling with contempt, how would he like the prospect of losing his job at 58 years of age and of having no old age pension at 65?

Mr. REMER: Awful.

Mr. DAVI ES: Of course it would be awful. It is a terrible state of affairs and no man can conceive all it means except one who is in that unfortunate position.

Mr. WALLHEAD: Can the hon. Gentleman state the estimated cost of this suggestion?

Mr. DAVIES: As far as I know, £50,000 per annum would settle the biggest part of the problem. I pass to something which is even worse than that. Under the last amending Act a man of 58½ years and over will be secure in respect of his pension rights but he loses his medical benefit, and, as the hon. Member for Gorbals (Mr. Buchanan) pointed out,
there must be 100,000 if not a larger number of men from 55 up to 58 who will probably never do a job again. Not only do they lose their medical but all other benefits.

Mr. BUCHANAN: Even the concession which the Minister has given does not help these men. Even the payment of arrears where the approved society is wealthy enough to do so does not keep their pension rights.

Mr. DAV I ES: It retains their other rights. I am going to appeal to the Ministry to do something in this case. It is not a very big issue but by taking some steps to deal with it the Ministry will bring succour to thousands of poor homes. At present the future is very black indeed. Above all, I think every Member of the Committee who takes a long view of our public health services will have been delighted to see the gradual decline in our infantile mortality rates. I have been looking at the figures recently, and find that the infantile mortality rate in 1871 was 140 and that in 1931 it stood at 66. But the most remarkable thing of all is this, that in 1871 the expectation of life at birth for a boy was 41 years, but in 1931 it was 56. In 1871 the expectation of life at birth for a girl was 44 years, and in 1931 it had risen to 60. That is a great achievement for those who have taken an interest in public welfare in the past. I hope that no member of any political party, in the Government or outside, will lend his aid to anything that will impair the splendid progress that has been made in public health in this country during the last 60 years.

Mr. WALLHEAD: Will the Minister tell us whether he has received any number of protests from approved societies against the application of this medical benefit and old age pensions question?

3.27 p.m.

The PARLIAMENTARY SECRETARY to the MINISTRY of HEALTH (Mr. Shakespeare): We have had a very interesting debate, and a multiplicity of points has been raised. If I do not answer them all, the reason is, frankly, the fact that I do not know the answer, because I have not been sufficiently long' at the Ministry to know a fraction of all that goes on in that great Department,
but I will do my best, and if I cannot answer, I will write to any hon. Member and give him a considered reply. Also the limitation of time will prevent me from answering all the questions, for if I tried to answer them all, I should be here about three hours. With regard to some of the points put by the hon. Member for Wegthoughton (Mr. Rhys Davies), the infant mortality rate for last year was 65, which is the second lowest rate since the war, and considering the hard times, I think the fact that that rate is down to 65 confirms what the Minister was saying earlier in the debate, that the acute depression has not according to our statistics had a perceptible effect on the general health of the country. Of course, the rate varies from year to year, but the curve of the graph is slowly coming down and—

Mr. RHYS DAVIES: The point I wanted to get at was how it came about that there was an increase of four per thousand in Scotland. Has it declined in England in 1932 by comparison with 1931?

Mr. SHAKESPEARE: I am not responsible for Scotland, and the hon. Member should address that question elsewhere. He raised the question of the effect of slum clearance on health and referred to the Stockton report, in which the local medical officer of health had reported that a certain number of slum tenants— 700, I think— who had been moved into a new estate had thereby suffered in health. That is rather a frightening report, but the facts are these, that it was an old slum clearance scheme, before the 1930 Act, when rents were much higher, and the slum tenants in question had to pay rents of something over 4s. more than they had been paying before. That would not happen now under the present conditions, because rents for alternative accommodation now compare very favourably with those paid in the slums, but in order to confirm the facts, we asked for the experience of several big cities, and they replied unanimously.
I have the reports from six cities. The death-rate on the new estates had halved in some cases and the infant mortality rate was one-third of its previous figure in the old slum estates. All the experience we have confirms what one would
expect, that if you take people out of hovels and overcrowded unhealthy areas you will improve their health. That is certainly true of the children. All the health officers report the greater health of the children, their brighter looks, and their capacity for mischief, which is the best test of any good healthy child. Of course, there may be an odd case where an old acclimatised slum dweller finds that when he is removed to healthier surroundings he becomes unhealthy. He is like a drug addict who has been deprived of his drugs; but that does not prove that drug taking is healthy. It is very relevant in the Stockton case to note that 90 per cent. of the new tenants were unemployed. If the remedy for the ill-health of the nation is to go back to the unhealthy slums our problem would be a simple one, but that is against common sense.
The hon. Gentleman went on to refer to the question of a Special Committee of the Board of Education to consider the school medical service. I have never heard of it. The hon. Member may be mixing up the old Ray Committee Report, but I will look into it. It is news to me and to everyone else in my Department. He went on to raise some technical points concerning the administration of approved societies, and he objected because a recent regulation provided that, in view of the piling up of surpluses in the administration fund, a certain amount at each valuation, that is, the excess over 1s. per member, should be put into the benefit fund and made available for additional benefits. It seems perfectly reasonable to me. It also covers his point in regard to the buildings. If an approved society has £1100,000 invested in stocks, that is included in the valuation, but if it is £100,000 invested in buildings, it is included in no valuation at all. There is no difference in principle between the two. This step is taken with the approval of the Consultative Council, and the hon. Gentleman should not object that part of the large accumulations in the administration fund of the approved societies will at the next valuation go towards additional benefits.
He raised the question of the effect of the Insurance Act passed last year on the 80,000 persons who already, as from the end of last year, have come out of sickness benefit, and who, at the end of
this year, will come out of medical benefit, but whose pension rights continue until the end of 1935. The House discussed and considered at great length the position of those men, and Parliament decided that they had been very generously treated. I must say that, having looked into the facts again in anticipation of this Debate, I am myself convinced that they have been exceptionally generously treated. I think the case made on their behalf does not stand investigation. What are the facts? The Health Insurance Fund is self-supporting, and if we are going to debauch that Fund as the Unemployment Insurance Fund has been debauched then the whole structure that has been built up will be undermined. These men—or some of them, in t/he extreme cases—have been kept in insurance since the year 1920. Every year since 1920 these men have been entitled to cash benefits and to all the rights of an ordinary insured person, yet they have not paid one penny in contributions. In other words, they have had 13 year's free insurance as regards sickness benefits, they will have had 14 years' free insurance as regards medical benefits, and two years more as regards pensions. Surely these men have been generously treated!
Last year Parliament decided that they must be treated as regards medical benefit in the same way as anybody else who does not come within the Insurance Fund. Surely we cannot, in law or morality, justify treating 80,000 persons on a different basis from that on which we treat everybody else. The basis of health insurance is that you receive benefits in relation to your contributions, and if we are going to tear that barrier down then we make the whole thing nonsense. The hon. Member for Gorbals (Mr. Buchanan) talked about the faith that one has in one's own doctor, and about these 80,000 men coming off the panel and having to go to district medical officers, and said that when one had become friendly with one's own doctor that was a hardship. We all love our doctors, but personally I love them when I do not see them; and when I am on holiday and have to go to another doctor I never regard it as a hardship. As a matter of fact in a very large number of cases the district medical officer is also a panel practitioner. It was said that it was hard for doctors all over the country to lose 80,000 panel patients, but
every year there are 150,000 new persons coming on to the panel. But if the question is only one of choice of doctor, and a local authority submits some sort of system whereby the district medical officers who are also panel practitioners may attend these men and the men have choice of doctors, then I am sure my right hon. Friend will consider it. The hon. Member for Merthyr (Mr. Wallhead) asked whether the approval of the approved societies had been obtained. The Committee will remember that this step was taken on the advice of the consultative committee, or in co-operation with them. It was approved by all the six groups of approved societies, including the trade union group, and I know of no approved society which did not agree—recognising, if you like, the grim necessity of passing the Act. I understand the opposition of the hon. Gentleman opposite, which has been consistent all through. It was consistent last year, it is consistent now. What I do not understand is the attitude of my hon. Friend the Senior Member for Dundee (Mr. Dingle Foot), who actually voted against some of the Amendments the party opposite then moved. It is a bit soon to start taking a different line.

Mr. RHYS DAVIE.S: The hon. Gentleman said the trade union group and the consultative council agreed with these provisions. Surely he must be aware that the consultative council does not agree to anything. It is a council to be consulted, and more often than not the Minister does not accept its advice.

Mr. SHAKESPEARE: My hon. Friend knows that if the right hon. Member for Wakefield (Mr. Greenwood) had been in office he would have taken a very similar step to that which we took last year. In fact, he was alarmed at the Government Actuary's report. He took action, in fact, which did not preserve the stability of the Fund. Then we took action after consulting the Consultative Committee and Advisory Committee. But one does not take action against the advice of an advisory committee.

Mr. DINGLE FOOT rose—

Mr. SHAKESPEARE: I have a great deal more to deal with and hope my hon. Friend will allow me to proceed.

Mr. BUCHANAN What about the 60 years?

Mr. SHAKESPEARE: There seems to have been some misunderstanding as to that effect of the Act passed last year. Before that Act was passed the position was that a man, if in employment at the age of 60, was safe as regards all insurance rights, in spite of any subsequent unemployment. What the Act did last year was to make a generous concession, and to say that if after the date of the passage of the Act a man had only reached the age of 581, and was then in employment, his insurance and pension rights would still not be affected by the casualties of unemployment. What hon. Members understood the Act to mean is not my business. That is the practice.

Mr. BUCHANAN: We thought that everyone in insurance—not in work—at 60, was safe.

Mr. SHAKESPEARE: The test was, was a man employed at the age of 58¼; if so, he is covered. Then there was a wrangle between two hon. Gentlemen of the medical profession into which I need not enter. The noble Lord the Member for Hastings (Lord E. Percy) raised an interesting point, which I am afraid I have not time to follow up very closely, but he objected to piecemeal town planning, I hope the county councils, as I believe they are, are increasingly approaching the problem through their regional committees. He wondered whether town planning could be coordinated with slum clearance, and he thought it should be. One hopes it will be; where there is a plan in operation, slum clearance will fit into that plan, and the noble Lord will remember no doubt that when a clearance order is made, the site is left in the hands of the owners subject to any town planning scheme that may be in force.
The hon. Member for Cardiff East (Mr. T. Morris) started by raising the question of the capital of Wales, a question into which I will not enter, but he also put three technical points to me to which I would rather reply by letter. He referred also to town planning, and I think his question was met by a recent article in the Board of Trade Journal on the industrial survey. The hon. Member for Leigh (Mr. Tinker), whose speech I very much enjoyed, asked me a question about the cost of timber. I said, in answer to a question in the House last week, that
if you took a house the capital cost of which was £350, the cost of timber would be roughly about £30. I also said that the Russian embargo had not sent up the cost of timber except in one area, and he replied that it had sent up the cost of timber in his area by 5 per cent. Even if it had, 5 per cent. On £30 is only 30s., so that the capital cost of a house increased from £350 to £351 10s., which would not make much difference in the rent. But the question does not arise now, because the Russian embargo is off. He gave us good advice to go on with our work. The hon. Member for Lichfield (Mr. Lovat-Fraser) raised the question of the treatment of children in workhouses. As he knows there are three practices. These is the practice of building cottage homes, and that of the acquisition and adaptation of country houses. About 800 children were re-housed by those two methods last year. There is the third practice of boarding children out, or, in London, by legal adoption under the Adoption of Children Act. The hon. Member complained that besides this, there were workhouses into which children were being put. In two cases throughout the country, I think, small workhouses have been take over and, as it were, reconditioned for the accommodation of children. That is much better than allowing children to remain in mixed workhouses, but it is only an experiment, and I do not think it is one to be generally encouraged.
The right hon. Gentleman the Member for Wakefield asked several questions about housing. Perhaps I may say one or two things in addition to what the Minister has said. Doubt was expressed during the Debates whether private enterprise would come in to undertake ordinary housing. I have noticed, that, since there has been a shortage of bricks, the same doubt has not been expressed. All the indications are that private enterprise intends to use the provisions under our Housing Act by which they can get an advance from the building societies up to 90 per cent. I do not know whether hon. Members have seen the two model houses erected in Aldwych. If not, I am sure they would be very interested to see them. They are a couple of cottages, each with three bedrooms, and the combined cost of the two cottages is £450, that is £225 each. [An HON. MEMBER: "Building cost
only?"] Yes, excluding land. The Exhibitors take the cost of the land at £500 per acre, with interest at 4½ per cent. —that is in London and the South—and say that the all-in rent, including rates, of such a house would be about 10s., and if you take interest at 4 per cent., which is the rate which prevails in the rest of the country, the all-in rent of such a house would be 8s. 6d. I think that that proves the point that I was trying to make during one of our Housing debates that private enterprise would, in time, get down to rents which would compare favourably with the rents of houses recently provided by local authorities under subsidy.
As regards slum clearance, I was very pleased to hear the declaration of the right hon. Gentleman the Member for Wakefield that he would do all in his power to help the campaign. I have always looked upon this campaign as above party. I said on a previous occasion that it is much bigger than party, and I should like to express the thanks of the Minister and myself for the very great help that we have bad from Members of all parties. They have been particularly active in using their influence in their own constituencies, in order to see that all the available means are now enlisted for a big national effort to rid this country of the disgrace which has been there too long. Since the War, as the Committee knows and down to 1930, demolition took place at the rate of about 1,000 houses a year. Since 1930, the rate has increased to about 3,000 and at the present time demolition over England and Wales is at the rate of 12,500. During the last three months, the resolutions that we have received from local authorities lead us to hope that next year, taking a conservative estimate, we shall clear the slums at the rate of not less than 24,000 a year. My right hon. Friend will not be satisfied unless, as a result of five years' programme, we have given a chance to at least 500,000 persons to live in more decent and healthier conditions.
That will be a gigantic task. It is a task that we can only carry through if we have the good will of everybody in all parties, and an awakened public conscience; and, thank goodness, the public conscience seems to be awakening at last. We look upon this as one of the greatest constructive tasks that has been faced by any Government within living
memory, and we are going to see it through to the end. We realise that difficulties and obstacles will probably emerge as we proceed, but we shall not allow any obstacles or difficulties to stand between us and the attainment of our object.
What of the response to the appeal which was sent out by my right hon. Friend to all local authorities, asking them to survey their slum problems and let us know what their five years' plan was7 Well, we received the first reply last week, from Stoke-on-Trent. It is to the effect that, whereas Stoke-on-Trent has been clearing at the rate of 19 houses a year since 1930, it now intends to clear, during five years, at a rate of between 700 and 800 a year—an increase of 4,000 per cent. Stoke-on-Treat has pride of place, and deserve our thanks for the way in which it has responded to the Minister's appeal.
I am particularly encouraged, although we have not yet got our programmes in, to notice the interest that has been recently taken in the rural problem, particularly in newspapers in rural areas. I frequently see that Members of Parliament have been making speeches and asking local authorities to utilise the provisions of the Act of 1926—the Reconditioning Act—or the Slum Clearance Act of 1930, which applies equally to rural areas. I was given an instance the other day of a rural district in my own county of Norfolk, which includes a number of scattered villages, and which is considering the demolition of 60 slum houses and the building of 60 new houses. It is particularly gratifying to know that all over the country rural district councils are getting down to the problem of housing in the rural areas. I think I have covered most of the points which have been raised in the Debate. I hope I have said enough to say that we are alive to these important questions which are now under our administration, and I hope that the whole House will be satisfied with the way in which we are dealing with them.

Mr. TINKER: The hon. Gentleman has not said anything on the subject of the clearing of refuse tips.

Mr. SHAKESPEARE: The problem of dealing with these big slag heaps is very difficult. Whether it would come within town planning, or whether it could be dealt with under schemes of occupational
employment, I do not know. I should like to think about it and discuss it with the hon. Member.

Mr. DINGLE FOOT: The bon. Gentleman suggested that I was repudiating the vote which I gave last year on the National Health Insurance Bill. I endeavoured to make it clear that I was not in any way attacking that Measure, but I did ask him, in view of the fact that a great many representations had been made to the Government by insurance committees, medical associations, and so forth, what is going to happen to the 100,000 people in England and Scotland who will pass out of medical benefit at the end of this year, and whether the Government propose to consider any of these representations and to make any kind of special arrangement to deal with them?

Mr. SHAKESPEARE: I am sorry if I misunderstood or misinterpreted my hon. Friend; I am glad to know that he has not repudiated the action that he took last year. In answer to his question, I have to say that there is no intention of departing from the line taken by Parliament last year. I think he raised the question of the transitional period. Really, these men have already had a very long transitional period; some of them have had a transitional period of 14 years without any contribution. I am afraid there is no hope along those lines.

3.55 p.m.

Viscount ELMLEY: About two months ago I brought to the notice of the House various points connected with local government, particularly affecting Norfolk. The first was the water supply. I was very glad that the Minister circularised local authorities on the subject, and I hope he had a gratifying response. I am glad to hear from the hon. Gentleman that, on the whole, he is expecting progress to be made under the Acts of 1926 and 1930, but I think even now he may find it necessary to put into operation some sort of measures to deal with those local authorities who will not do their duty. In one or two cases that will be found to be quite necessary. I see that recently 24 English and ten Welsh counties met together and put forward very similar suggestions to what I did regarding block grants. I hope the
Minister has considered the Memorandum that they sent out and will do his best to meet them. At the moment unemployment is as low as it ever is during the year. In Norfolk it is practically nonexistent, but that is not the case in the early part of the year. From about next December the figures will get very high indeed, and I hope that in the autumn there will be brought in the Bill to deal with the whole question of poor relief. Our great problems are that we have no training centres where people can be taught something useful. For geographical reasons that is impossible. That makes it all the harder to know what to do with the people, especially as no other useful form of relief work has yet been devised. I hope that in that legislation the point relating to those who have no unemployment insurance will be had regard to.

3.58 p.m.

Mr. WALLHEAD: I spoke very strongly against the Bill of 1933 and said what would be the effect in me Division. I asked the hon. Gentleman what reply he had received from the approved societies. Perhaps I should have asked what opposition he had received from medical insurance societies and committees, because my information is that a large number of them are very much afraid of the operation of the Act. My association in Merthyr Tydvil is very apprehensive of what is going to be the effect upon very large numbers of persons. They have petitioned the Government as to whether they could not do something to extend the operation of the original Act and prevent this Measure operating in the very adverse way that it will.

It being Four o'ClockCHAIRMAN left the Chair to make his Report to the House.

Committee report Progress; to sit again upon Monday next.

The remaining Orders were read, and postponed.

Whereupon Mr. SPEAKER adjourned the House without Question put, pursuant to Standing Order No. 3.

Adjourned at One Minute after Four o'Clock, until Monday next, 10th July.